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The World Health Organization ranks hypertension the leading global risk factor for disease, specifically, cardiovascular disease. Blood pressure (BP) is higher in Westernized populations consuming Na + -rich processed foods than in isolated societies consuming K + -rich natural foods. Evidence suggests that lowering dietary Na +  is particularly beneficial in hypertensive individuals who consume a high-Na +  diet. Nonetheless, numerous population studies demonstrate a relationship between higher dietary K + , estimated from urinary excretion or dietary recall, and lower BP, regardless of Na +  intake. Interventional studies with K +  supplementation suggest that it provides a direct benefit; K +  may also be a marker for other beneficial components of a “natural” diet. Recent studies in rodent models indicate mechanisms for the K +  benefit: the distal tubule Na + -Cl −  cotransporter (NCC) controls Na +  delivery downstream to the collecting duct, where Na +  reabsorbed by epithelial Na +  channels drives K +  secretion and excretion through K +  channels in the same region. High dietary K +  provokes a decrease in NCC activity to drive more K +  secretion (and Na +  excretion, analogous to the actions of a thiazide diuretic) whether Na +  intake is high or low; low dietary K +  provokes an increase in NCC activity and Na +  retention, also independent of dietary Na + . Together, the findings suggest that public health efforts directed toward increasing consumption of K + -rich natural foods would reduce BP and, thus, cardiovascular and kidney disease.

endocrinology and metabolism/american journal of physiology: endocrinology and metabolism

Cardiovascular benefits associated with higher dietary K<sup>+</sup> vs. lower dietary Na<sup>+</sup>: evidence from population and mechanistic studies

Cardiovascular benefits associated with higher dietary K+ vs. lower dietary Na+: evidence from population and mechanistic studies

Cardiovascular benefits associated with higher dietary K⁺ vs. lower dietary Na⁺: evidence from population and mechanistic studies