Effects of oral potassium on blood pressure: Meta-analysis of randomized controlled clinical trials

JAMA

Volumn 277, Issue 20, 1997, Pages 1624-1632

  Whelton, Paul K ^a,c,d   He, Jiang ^a   Cutler, Jeffrey A ^b   Brancati, Frederick L ^a   Appel, Lawrence J ^a   Follmann, Dean ^b   Klag, Michael J ^a  

^a JOHNS HOPKINS UNIVERSITY   (United States)

^b NATIONAL HEART LUNG AND BLOOD INSTITUTE   (United States)

^c TULANE UNIVERSITY   (United States)

^d Office of the Dean   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BICARBONATE; CITRATE POTASSIUM; POTASSIUM; POTASSIUM CHLORIDE; SODIUM CHLORIDE;

CLINICAL TRIAL; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; DIASTOLIC BLOOD PRESSURE; DIET SUPPLEMENTATION; HUMAN; HYPERTENSION; META ANALYSIS; ORAL DRUG ADMINISTRATION; POTASSIUM INTAKE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL; REVIEW; SYSTOLIC BLOOD PRESSURE;

EID: 0030956083     PISSN: 00987484     EISSN: None     Source Type: Journal    
DOI: 10.1001/jama.277.20.1624     Document Type: Review

References (97)

1. Whelton PK. Epidemiology of hypertension. Lancet. 1994;344:101-106.
2. Intersalt Cooperative Research Group. Intersalt: an international study of electrolyte excretion and blood pressure: results for 24 hour urinary sodium and potassium excretion. BMJ. 1988;297:319-328.
3. Shaper AG, Pocock SJ, Walker M, Cohen NM, Wale CJ, Thomson AG. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. BMJ. 1981;283:179-186.
4. Bruce N, Wannamethee G, Shaper AG. Lifestyle factors associated with geographic blood pressure variations among men and women in the UK. J Hum Hypertens. 1993;7:229-238.
5. Smith WC, Crombie IK, Tavendale RT, Gulland SK, Tunstall-Pedoe H. Urinary electrolyte excretion, alcohol consumption, and blood pressure in the Scottish Heart Health Study. BMJ. 1988;297:329-330.
6. Prior IAM,Stanhope JM,Evans JG, Salmond CE. The Tokelau Island Migrant Study. Int J Epidemiol. 1974;3:225-232.
7. Sever PS, Gordon D, Peart WS, Beighton P. Blood pressure and its correlates in urban and tribal Africa. Lancet. 1980;2:60-64.
8. Poulter NR, Khaw KT, Hopwood BE, et al. The Kenyan Luo migration study: observations on the initiation of a rise in blood pressure. BMJ. 1990;300: 967-972.
9. He J, Klag MJ, Whelton PK, et al. Migration, blood pressure pattern, and hypertension. Am J Epidemiol. 1991;134:1085-1101.
10. Working Group on Primary Prevention of Hypertension. Report of the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension. Arch Intern Med. 1993; 153:186-208.
11. Beilin LJ. Diet and hypertension: critical concepts and controversies. J Hypertens. 1987;5(suppl 5):S447-S457.
12. Walker WG, Whelton PK, Saito H, Russell RP, Hermann J. Relation between blood pressure and renin, renin substrate, angiotensin II, aldosterone and urinary sodium and potassium in 574 ambulatory subjects. Hypertension. 1979;1:287-291.
13. Lever AF, Beretta-Piccoli C, Brown JJ, Davies DL, Fraser R, Robertson JS. Sodium and potassium in essential hypertension. BMJ. 1981;283:463-468.
14. Khaw KT, Rose G. Population study of blood pressure and associated factors in St Lucia, West Indies. Int J Epidemiol. 1982;11:372-377.
15. Langford HG. Dietary potassium and hypertension: epidemiologic data. Ann Intern Med. 1983;98: 770-772.
16. Dai WS, Kuller LH, Miller G. Arterial blood pressure and urinary electrolytes. J Chronic Dis. 1984; 37:75-84.
17. Simpson FO. Monovalent and divalent cations in hypertension. Prev Med. 1985;14:436-450.
18. Reed D, McGee D, Yano K, Hankin J. Diet, blood pressure, and multicollinearity. Hypertension. 1985; 7:405-410.
19. Addison WLT. The use of sodium chloride, potassium chloride, sodium bromide and potassium bromide in cases of arterial hypertension which are amenable to potassium chloride. Can Med Assoc J. 1928; 18:281-285.
20. Priddle WW. Observations on the management of hypertension. Can Med Assoc J. 1931;25:5-8.
21. McQuarrie I, Thompson WH, Anderson JA. Effects of excessive ingestion of sodium and potassium salts on carbohydrate metabolism and blood pressure in diabetic children. J Nutr. 1936;11:77-101.
22. Gros G, Weller JM, Hoobler SW. Relationship of sodium and potassium intake to blood pressure. Am J Clin Nutr. 1971;24:605-608.
23. Mickelson O, Makdani D, Gill JL, Frank RL. Sodium and potassium intakes and excretions of normal men consuming sodium chloride or a 1:1 mixture of sodium and potassium chlorides. Am J Clin Nutr. 1977;30:2033-2040.
24. Burstyn P, Hornall D, Watchorn C. Sodium and potassium intake and blood pressure. BMJ. 1980;2: 537-539.
25. Iimura O, Kijima T, Kikuchi K, et al. Studies on the hypotensive effect of high potassium intake in patients with essential hypertension. Clin Sci. 1981; 61(suppl 7):77s-80s.
26. Parfrey PS, Wright P, Holly JMP, et al. Blood pressure and hormonal changes following alteration in dietary sodium and potassium in young men with and without a familial predisposition to hypertension. Lancet. 1981;1:113-117.
27. Parfrey PS, Wright P, Goodwin FJ, et al. Blood pressure and hormonal changes following alteration in dietary sodium and potassium in mild essential hypertension. Lancet. 1981;1:59-63.
28. Holly JMP, Goodwin FJ, Evans SJW, Vandenburg MJ, Ledingham JM. Re-analysis of data in two Lancet papers on the effect of dietary sodium and potassium on blood pressure. Lancet. 1981;2:1384-1386.
29. Gillum RF, Prineas RJ, Kebede J. Independent effects of Na reduction and K supplementation on blood pressure. Am Heart J. 1982;103:449.
30. Morgan TO. The effect of potassium and bicarbonate ions on the rise in blood pressure caused by sodium chloride. Clin Sci. 1982;63:407s-409s.
31. Smith SJ, Markandu ND, Sagnella GA, Poston L, Hilton PJ, MacGregor GA. Does potassium lower blood pressure by increasing sodium excretion? a metabolic study in patients with mild to moderate essential hypertension. J Hypertens. 1983;1:27-30.
32. Overlack A, Muller H-M, Kolloch R, et al. Long-term antihypertensive effect of oral potassium in essential hypertension. J Hypertens. 1983;1(suppl 2): 165-167.
33. Fujita T, Ando K. Hemodynamic and endocrine changes associated with potassium supplementation in sodium-loaded hypertensive. Hypertension. 1984; 6:184-192.
34. Jeffery RW, Pirie PL, Elmer PJ, et al. Low-sodium, high-potassium diet: feasibility and acceptability in a normotensive population. Am J Public Health. 1984;74:492-494.
35. Tabuchi Y, Ogihara T, Gotoh S, Masuo K, Hashizume K, Kumahara Y. Hypotensive mechanism of potassium supplementation in salt-loaded patients with essential hypertension. J Clin Hypertens. 1985; 2:145-152.
36. Weissberg PL, West MJ, Kendall MJ, Ingram M, Woods KL. Effect of changes in dietary sodium and potassium on blood pressure and cellular electrolyte handling in young normotensive subjects. J Hypertens. 1985;3:475-480.
37. Budrikis G. Potassium supplements for hypertension: lessons learned from a trial in general practice. Aust Fam Phys. 1985;14:1340-1341.
38. Os I, Kjeldsen SE, Westheim A, et al. The effect of sodium depletion and potassium supplementation on vasopressin, renin and catecholamines in hypertensive men. Acta Med Scand. 1986;220:195-203.
39. Miller JZ, Weinberger MH. Blood pressure response to sodium restriction and potassium supplementation in healthy normotensive children. Clin Exp Theory Pract. 1986;4-5:823-827.
40. Arzilli P, Taddei S, Graaadei L, Bichisao E, Giovannetti R, Salvetti A. Potassium-rich and sodium-poor salt reduces blood pressure in hospitalized patients. J Hypertens. 1986;4:S347-S350.
41. Miller JZ, Weinberger MH, Christian JC. Blood pressure response to potassium supplementation in normotensive adults and children. Hypertension. 1987; 10:437-442.
42. Forrester TE, Grell GAC. Changes in red cell sodium content and blood pressure levels with potassium supplementation in black hypertensive patients. West Indian Med J. 1988;37:92-96.
43. Salvetti A, Bichisao E, Caiazza A, et al. The combination of alow-Na/high-K salt with metoprolol in the treatment of mild-moderate hypertension: a multicenter study. Am J Hypertens. 1988;1:201S-205S.
44. Bompiani GD, Cerasola G, Morici ML, et al. Effects of moderate low sodium/high potassium diet on essential hypertension: results of a comparative study. Int J Clin Pharmacol Ther Toxicol. 1988;26:129-132.
45. Grimm RH, Neaton JD, Elmer PJ, et al. The influence of oral potassium chloride on blood pressure in hypertensive men on a low-sodium diet. N Engl J Med. 1990;322:569-574.
46. Obel AO, Koech DK. Potassium supplementation versus bendrofluazide in mildly to moderately hypertensive Kenyans. J Cardiovasc Pharmacol. 1991;17:504-507.
47. Siani A, Strazzullo P, Giacco A, Pacioni D, Celentano E, Mancini M. Increasing the dietary potassium intake reduces the need for antihypertensive medication. Ann Intern Med. 1991;115:753-759.
48. Sinaiko AR, Gomez-Marin O, Prineas R. Effect of low sodium diet or potassium supplementation on adolescent blood pressure. Hypertension. 1993;21: 989-994.
49. Singh RB, Rastogi SS, Singh NK, Ghosh S, Gupta S, Niaz MA. Can guava fruit intake decrease blood pressure and blood lipids? J Hum Hypertens. 1993; 7:33-38.
50. Skrabal F, Aubock J, Hortnagl H. Low sodium/high potassium diet for prevention of hypertension: probable mechanisms of action. Lancet. 1981;1:895-900.
51. MacGregor GA, Smith SJ, Markandu ND, Banks RA, Sagnella GA. Moderate potassium supplementation in essential hypertension. Lancet. 1982;2:567-570.
52. Khaw KT, Thom S. Randomized double-blind cross-over trial of potassium on blood pressure in normal subjects. Lancet. 1982;2:1127-1129.
53. Richards AM, Nicholls MG, Espiner EA, et al. Blood pressure response to moderate sodium restriction and to potassium supplementation in mild essential hypertension. Lancet. 1984;1:757-761.
54. Smith SJ, Markandu ND, Sagnella GA, MacGregor GA. Moderate potassium chloride supplementation in essential hypertension: is it additive to moderate sodium restriction? BMJ. 1985;290:110-113.
55. Kaplan NM, Carnegie A, Raskin P, Heller J, Summons M. Potassium supplementation in hypertensive patients with diuretic-induced hypokalemia. N Engl J Med. 1985;312:746-749.
56. Zoccali C, Cumming AMM, Hutcheson MJ, Barnett P, Semple PF. Effects of potassium on sodium balance, renin, noradrenaline and arterial pressure. J Hypertens. 1985;3:67-72.
57. Bulpitt CJ, Ferner G, Lewis PJ, Daymond M, Bulpitt PF, Dollery CT. Potassium supplementation fails to lower blood pressure in hypertensive patients receiving a potassium losing diuretic. Ann Clin Res. 1985;17:126-130.
58. Matlou SM, Isles CG, Higgs A, et al. Potassium supplementation in blacks with mild to moderate essential hypertension. J Hypertens. 1986;4:61-64.
59. Barden AE, Vandongen R, Beilin LJ, Bargetts B, Rogers P. Potassium supplementation does not lower blood pressure in normotensive women.J Hypertens. 1986;4:339-343.
60. Poulter NR, Sever PS. Moderate potassium supplementation: ineffective in black normotensives. East Afr Med J. 1986;63:798-802.
61. Chalmers J, Morgan T, Doyle A, et al. Australian National Health and Medical Research Council Dietary Salt Study in Mild Hypertension. J Hypertens. 1986;4(suppl 6):S629-S637.
62. Grobbee DE, Hofman A, Roelandt JT, Boomsma F, Schalekamp MA, Valkenburg HA. Sodium restriction and potassium supplementation in young people with mildly elevated blood pressure. J Hypertens. 1987;5:115-119.
63. Siani A, Strazzullo P, Russo L, et al. Controlled trial of long-term oral potassium supplements in patients with mild hypertension. BMJ. 1987;294:1453-1456.
64. Svetkey LP, Yarger WE, Feussner JR, DeLong E, Klotman PE. Double-blind, placebo-controlled trial of potassium chloride in the treatment of mild hypertension. Hypertension. 1987;9:444-450.
65. Medical Research Council Working Party. Comparison of the antihypertensive efficacy and adverse reactions to two doses of bendrofluazide and hydrochlorothiazide and the effect of potassium supplementation on the hypotensive action of bendrofluazide: sub-studies of the Medical Research Council's Trials of Treatment of Mild Hypertension. J Clin Pharmacol. 1987;27:271-277.
66. Grimm RH, Kofron PM, Neaton JD, et al. Effect of potassium supplementation combined with dietary sodium reduction on blood pressure in men taking antihypertensive medication. J Hypertens, 1988;6 (suppl 4):S591-S593.
67. Cushman WC, Langford HG. Randomized controlled trial of potassium chloride versus placebo in mildly hypertensive blacks and whites. Circulation. 1988;78:II-370. Abstract.
68. Obel AO. Placebo-controlled trial of potassium supplements in black patients with mild essential hypertension. J Cardiovasc Pharmacol. 1989;14:294-296.
69. Krishna GG, Miller E, Kapoor S. Increased blood pressure during potassium depletion in normotensive men. N Engl J Med. 1989;320:1177-1182.
70. Hypertension Prevention Trial Research Group. The Hypertension Prevention Trial: three-year effects of dietary changes on blood pressure. Arch Intern Med. 1990;150:153-162.
71. Mullen JT, O'Connor DT. Potassium effects on blood pressure: is the conjugate anion important? J Hum Hypertens. 1990;4:589-596.
72. Patki PS, Singh J, Gokhale SV, Bulakh PM, Shrotri DS, Patwardham B. Efficacy of potassium and magnesium in essential hypertension: a double blind, placebo controlled, crossover study. BMJ. 1990; 301:521-523.
73. Valdes G, Vio CP, Montero J, Avendano R. Potassium supplementation lowers blood pressure and increases urinary kallikrein in essential hypertensives. J Hum Hypertens. 1991;5:91-96.
74. Barden A, Beilin LJ, Vandongen R, Puddey IB. A double-blind placebo-controlled trial of the effects of short-term potassium supplementation on blood pressure and atrial natriuretic peptide in normotensive women. Am J Hypertens. 1991;4:206-213.
75. Overlack A, Conrad H, Stumpe KO. The influence of oral potassium citrate/bicarbonate on blood pressure in essential hypertension during unrestricted salt intake. Klin Wochenschr. 1991;69:79-83.
76. Smith SR, Klotman PE, Svetkey LP. Potassium chloride lowers blood pressure and causes natriuresis in older patients with hypertension. J Am Soc Nephrol. 1992;2:1302-1309.
77. Fotherby MD, Potter JF. Potassium supplementation reduces clinic and ambulatory blood pressure in elderly hypertensive patients. J Hypertens. 1992; 10:1403-1408.
78. Whelton PK, Birring J, Borhani NO, et al, for the Trials of Hypertension Prevention (TOHP) Collaborative Research Group. The effect of potassium supplementation in persons with a high-normal blood pressure: results from phase I of the Trials of Hypertension Prevention. Ann Epidemiol. 1995;5:85-95.
79. Brancati FL, Appel LJ, Seidler AJ, Whelton PK. Potassium supplementation reduces blood pressure in African Americans. Arch Intern Med. 1996;156: 61-67.
80. Whelton PK, Klag MJ. Potassium in the homeostasis and reduction of blood pressure. Clin Nutr. 1987;6:76-85.
81. Kaplan NM, Ram CVS. Potassium supplementation for hypertension. N Engl J Med. 1990;322: 623-624.
82. Cappuccio FP, MacGregor GA. Does potassium supplementation lower blood pressure? a meta-analysis of published trials. J Hypertens. 1991;9:465-473.
83. Rice JA. Mathematical Statistics and Data Analysis. Belmont, Mass: Duxbury Press; 1988.
84. Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769-773.
85. Jones DR. Meta-analysis: weighing the evidence. Stat Med. 1995;14:137-149.
86. National Research Council. Combining Information: Statistical Issues and Opportunities fur Research. Washington, DC: National Academy Press; 1992.
87. DerSimonian R, Laird N. Meta-analysis in clinical trials. Controlled Clin Trials. 1986;7:177-188.
88. Whelton PK. Potassium and blood pressure. In: Izzo JL, Black HR, eds. Hypertension Primer: The Essentials of High Blood Pressure. Dallas, Tex: American Heart Association; 1993:170-173.
89. Grobbee DE. Electrolyte intake and human hypertension, A: sodium and potassium. In: Swales JD, ed. Textbook of Hypertension. Oxford, England: Blackwell Scientific Publications; 1994:539-551.
90. Whelton PK, Appel LA, Seidler AJ, Thaker GK, Klag MJ. Potassium supplementation in the treatment and prevention of hypertension. J Hypertens. 1992;10(suppl 4):S108. Abstract.
91. Schulz KF, Chalmers I, Hayes RJ, Altaman DG. Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;273: 408-412.
92. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease, part 1: prolonged differences in blood pressure: prospective observational studies corrected for the regression bias. Lancet. 1990;335:765-774.
93. Klag MJ, Whelton PK, Appel LJ. Effect of age on the efficacy of blood pressure treatment strategies. Hypertension. 1990;16:700-705.
94. Stamler R. Implications of the INTERSALT study. Hypertension. 1991;17(suppl 1):I-16-I-20.
95. Brunner HR, Baer LB, Sealy JE, Ledingham JGG, Laragh JH. The influence of potassium administration and of potassium deprivation on plasma renin in normal and hypertensive subjects. J Clin Invest. 1970;49:2128-2138.
96. Treasure J, Ploth D. Role of dietary potassium in the treatment of hypertension. Hypertension. 1983; 5:864-872.
97. Tannen RL. Effects of potassium on blood pressure control. Ann Intern Med. 1983;98:773-780.