What amount of supplemental potassium (K+) is recommended to help lower blood pressure (hypertension)?

Recommended Potassium Supplementation for Blood Pressure Reduction

For blood pressure reduction, dietary potassium intake of 1500-3000 mg (approximately 40-75 mmol) per day is recommended, which can be achieved through 4-5 servings of fruits and vegetables daily or through supplementation in patients without renal impairment. 1

Dietary vs. Supplemental Potassium

• Dietary potassium through fruits, vegetables, and low-fat dairy products is the preferred method for increasing potassium intake for blood pressure control 1
• Good dietary sources include avocados, nuts, seeds, legumes, tofu, fruits (especially bananas, oranges, apples), vegetables (potatoes, spinach, tomatoes, lettuce), and selected fish and meats 1
• One medium banana contains approximately 450 mg (12 mmol) of potassium 2
• For patients without renal impairment who cannot achieve adequate dietary intake, potassium supplementation can be considered 1

Efficacy for Blood Pressure Reduction

• Meta-analyses show that potassium supplementation significantly lowers systolic blood pressure by 5.9 mmHg (95% CI: 5.2-6.6 mmHg) and diastolic blood pressure by 3.4 mmHg (95% CI: 2.8-4.0 mmHg) 3
• The effect is more pronounced in hypertensive patients, with reductions of 8.2 mmHg systolic and 4.5 mmHg diastolic 3
• The dose-response relationship indicates approximately 1.0 mmHg reduction in systolic BP and 0.52 mmHg reduction in diastolic BP per 0.6 g (15 mmol) per day increase in potassium intake 4
• The average reduction with 4.7 g (120 mmol) of dietary potassium per day is 8.0/4.1 mmHg 4

Dosing Recommendations

• The 2023 European Society of Hypertension guidelines recommend increased potassium consumption, preferably via dietary modification, for adults with elevated BP 1
• The 2017 ACC/AHA guidelines recommend 4-5 servings of fruits and vegetables daily, providing 1500-3000 mg of potassium 1
• The Japanese Society of Hypertension recommends a daily potassium intake of ≥3000 mg 1
• The Korean Society of Hypertension recommends a potassium intake of 120 mmol/day (approximately 4700 mg) 1
• Initial dosing of oral potassium supplementation should start at the lower end of the range (20 mEq/day) and be gradually increased to minimize gastrointestinal adverse effects 2

Factors Affecting Response

• Patients with lower baseline potassium intake (<90 mmol/day) show greater blood pressure reductions with supplementation 5
• Higher sodium intake (≥4g/day) and higher sodium-to-potassium ratio are associated with greater blood pressure lowering effects from potassium supplementation 5
• Black individuals typically experience greater blood pressure reductions than Caucasians with equal potassium intake 4
• Longer duration of supplementation is associated with more pronounced blood pressure lowering effects 3

Important Cautions and Contraindications

• Potassium supplementation is contraindicated in patients with advanced chronic kidney disease 1
• Caution is advised when using potassium supplements in patients taking potassium-sparing diuretics, ACE inhibitors, or angiotensin receptor blockers due to increased risk of hyperkalemia 2
• Potassium supplements should be divided into 2-4 doses throughout the day for better tolerance and absorption 2
• Monitoring of serum potassium and creatinine is recommended after 5-7 days of therapy and continued every 5-7 days until potassium values are stable 2

Clinical Algorithm for Potassium Supplementation

1. Assess baseline potassium intake and renal function
2. For patients with normal renal function:
   • First recommend increasing dietary potassium through 4-5 servings of fruits and vegetables daily (target: 1500-3000 mg/day)
   • If dietary changes are insufficient, consider potassium supplementation starting at 20 mEq/day
   • Gradually increase to 40-75 mmol/day (1500-3000 mg/day) as tolerated
3. Monitor serum potassium and renal function after 5-7 days and adjust dosage accordingly
4. Continue supplementation as long as blood pressure control is needed and no contraindications develop