Potassium Intake and Blood Pressure: A Dose‐Response Meta‐Analysis of Randomized Controlled Trials

<jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Epidemiologic studies, including trials, suggest an association between potassium intake and blood pressure ( <jats:styled-content style="fixed-case">BP</jats:styled-content> ). However, the strength and shape of this relationship is uncertain. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> We performed a meta‐analysis to explore the dose‐response relationship between potassium supplementation and <jats:styled-content style="fixed-case">BP</jats:styled-content> in randomized‐controlled trials with a duration ≥4 weeks using the recently developed 1‐stage cubic spline regression model. This model allows use of trials with at least 2 exposure categories. We identified 32 eligible trials. Most were conducted in adults with hypertension using a crossover design and potassium supplementation doses that ranged from 30 to 140 mmol/d. We observed a U‐shaped relationship between 24‐hour active and control arm differences in potassium excretion and <jats:styled-content style="fixed-case">BP</jats:styled-content> levels, with weakening of the <jats:styled-content style="fixed-case">BP</jats:styled-content> reduction effect above differences of 30 mmol/d and a <jats:styled-content style="fixed-case">BP</jats:styled-content> increase above differences ≈80 mmol/d. Achieved potassium excretion analysis also identified a U‐shaped relationship. The <jats:styled-content style="fixed-case">BP</jats:styled-content> ‐lowering effects of potassium supplementation were stronger in participants with hypertension and at higher levels of sodium intake. The <jats:styled-content style="fixed-case">BP</jats:styled-content> increase with high potassium excretion was noted in participants with antihypertensive drug‐treated hypertension but not in their untreated counterparts. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> We identified a nonlinear relationship between potassium intake and both systolic and diastolic <jats:styled-content style="fixed-case">BP</jats:styled-content> , although estimates for <jats:styled-content style="fixed-case">BP</jats:styled-content> effects of high potassium intakes should be interpreted with caution because of limited availability of trials. Our findings indicate an adequate intake of potassium is desirable to achieve a lower <jats:styled-content style="fixed-case">BP</jats:styled-content> level but suggest excessive potassium supplementation should be avoided, particularly in specific subgroups. </jats:p> </jats:sec>