Sodium, potassium, and cardiovascular disease
Several studies suggest that we should promote low-sodium, high-potassium diets — especially in patients with hypertension. Sodium restriction and generous potassium intake are associated with lower blood pressure (BP), but the ultimate effect on cardiovascular (CV)-related morbidity is unclear.
In 2021, several studies addressed this issue and refocused attention on these dietary interventions. In a trial from China, 21,000 people with histories of stroke or inadequately controlled hypertension were randomised to replace regular salt with a salt substitute (75% sodium chloride, 25% potassium chloride) or to continue using regular salt; to further enhance sodium restriction, intervention participants were instructed to use the salt substitute more sparingly than they had used regular salt.
At 5 years, rates of stroke, major adverse CV events, and mortality were each significantly lower in the salt-substitute group — by roughly 2 or 3 events per 100 participants. According to 24-hour urine electrolyte measurements, the intervention lowered sodium intake by only about 10% but increased potassium intake by about 50%.
Source: The New England Journal of Medicine
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