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The Impact of Sodium and Potassium on Hypertension Risk

  • Horacio J. Adrogué
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, TX

    Department of Medicine, Houston Methodist Hospital, Houston, TX

    Renal Section, Veterans Affairs Medical Center, Houston, TX
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  • Nicolaos E. Madias
    Correspondence
    Address reprint requests to Nicolaos E. Madias, MD, Department of Medicine, St. Elizabeth’s Medical Center, 736 Cambridge St, Boston, MA 02135
    Affiliations
    Department of Medicine, Tufts University School of Medicine, Boston, MA

    Department of Medicine, Division of Nephrology, St. Elizabeth’s Medical Center, Boston, MA
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      Summary

      The pathogenic role of sodium surfeit in primary hypertension is widely recognized but that of potassium deficiency usually has been ignored or at best assigned subsidiary status. Weighing the available evidence, we recently proposed that the chief environmental factor in the pathogenesis of primary hypertension and the associated cardiovascular risk is the interaction of the sodium surfeit and potassium deficiency in the body. Here, we present the major evidence highlighting the relationship between high-sodium intake and hypertension. We then examine the blood pressure–lowering effects of potassium in conjunction with the pernicious impact of potassium deficiency on hypertension and cardiovascular risk. We conclude with summarizing recent human trials that have probed the joint effects of sodium and potassium intake on hypertension and its cardiovascular sequelae. The latter studies lend considerable fresh support to the thesis that the interaction of the sodium surfeit and potassium deficiency in the body, rather than either disturbance by itself, is the critical environmental factor in the pathogenesis of hypertension.

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