How can potassium supplementation be used to manage hypertension?

From the Guidelines

Potassium supplementation can be an effective adjunct to manage hypertension, with a recommended daily intake of 3,510-4,700 mg, as suggested by the World Health Organization and the 2015 Dietary Guidelines for Americans 1. To achieve this, adults can consume potassium-rich foods like bananas, potatoes, avocados, spinach, and yogurt, or take supplements, typically potassium chloride, in doses of 595-1,190 mg (15-30 mEq) daily, divided into 2-3 doses with meals to minimize gastrointestinal discomfort. The mechanism of potassium in lowering blood pressure involves promoting sodium excretion, relaxing blood vessel walls, and balancing the effects of sodium on blood pressure, as supported by studies 1. However, certain individuals, such as those taking ACE inhibitors, ARBs, or potassium-sparing diuretics, or those with kidney disease, should consult healthcare providers before supplementing with potassium due to the risk of hyperkalemia 1. Regular blood pressure monitoring and occasional blood tests to check potassium levels are recommended when using supplements. Key points to consider when supplementing with potassium include:

• Starting with a low dose and gradually increasing as needed and under medical supervision
• Monitoring potassium levels and adjusting the dose accordingly
• Being aware of potential interactions with other medications, such as RAAS inhibitors, which can increase the risk of hyperkalemia 1
• Considering dietary changes as the first approach, with supplements reserved for those unable to meet needs through food alone
• Being cautious in patients with advanced CKD or those with hyporeninemic hypoaldosteronism or other causes of impaired potassium excretion, as they may be at higher risk of hyperkalemia 1.

From the FDA Drug Label

For the treatment of hypertension: • Concomitant use of potassium supplements or potassium-sparing diuretics ( 4)

The FDA drug label does not answer the question.

From the Research

Potassium Supplementation for Hypertension Management

• Potassium supplementation may be effective in reducing blood pressure in patients with hypokalemia during diuretic therapy 2
• Increasing dietary potassium intake has been demonstrated to significantly lower blood pressure in a dose-responsive manner in both hypertensive and nonhypertensive patients 3
• The average reduction in blood pressure with 4.7 g (120 mmol) of dietary potassium per day is 8.0/4.1 mm Hg, depending on race and the relative intakes of other minerals such as sodium, magnesium, and calcium 3

Recommended Daily Intake of Potassium

• The daily dietary intake of potassium should be 60 mmol or more, as this level of intake has been associated with a reduced risk of stroke-related mortality 2
• An adequate dietary intake of potassium, in the order of 90mmol/day, should be achieved for blood pressure control 4

Effectiveness of Potassium Supplementation

• Potassium supplementation decreased systolic blood pressure by 4.48mmHg and diastolic blood pressure by 2.96mmHg in hypertensive subjects 4
• Lower (<90mmol/day) potassium intake at baseline was associated with a higher blood-pressure lowering effect 4
• Potassium supplementation has a modest blood pressure-lowering effect in normotensive persons with low dietary intake 5

Interactions with Other Minerals

• The administration of calcium and magnesium with potassium did not enhance the effect of potassium alone 6, 5
• Higher sodium intake (particularly ≥4g/day) and higher sodium-to-potassium ratio were associated with a higher blood-pressure lowering effect of potassium supplementation 4