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The 2019 National Academy of Science, Engineering and Medicine Dietary Reference Intakes (DRI) for Sodium (Na + ) and Potassium (K + ) Report concluded there remains insufficient evidence to establish a K + DRI. This study tested the hypothesis that reduced Na + and increased K + excretion will positively associate with lower blood pressure in salt sensitive (SS) and salt resistant (SR) participants in the Dietary Approaches to Stop Hypertension Sodium Trial (DASH-Sodium). Via the NHLBI BioLINCC we accessed the DASH-Sodium dataset for data on systolic blood pressure (SBP), 24-h urinary Na + and K + excretion at screening (regular patient diet; N = 186, SS N = 222 SR) and post DASH diet (N = 71 SS, N = 119 SR). The relationships between SBP, urinary Na + and K + excretion, and Na + /K + ratio were assessed via linear regression. At screening elevated urinary Na + excretion positively associated with SBP in SS (1 g increase in urinary Na + excretion = +1 0 ± 0.4 mmHg) but not SR participants, and urinary K + excretion of &lt;1 g K + /day was associated with higher SBP in SS and SR participants. Urinary K + excretion ≥1 g/day, or a decreases in urinary Na + /K + ratio, was not associated with lower SBP. Post the DASH-sodium diet intervention, SBP was reduced in SS and SR participants. However, no correlation was observed between reduced SBP and urinary K + excretion or the urinary Na + /K + ratio irrespective of the salt sensitivity of blood pressure. Our data support the DRI recommendation not to establish a K + DRI and suggest further evidence is required to support a reduced Na + /K + ratio to lower SBP.

Association of urinary sodium and potassium excretion with systolic blood pressure in the Dietary Approaches to Stop Hypertension Sodium Trial