Abstract
Background: Evidence-based dietary recommendations for sodium and potassium have been made for adults with hypertension. Foods high in sodium are typically low in potassium and vice versa. This study aimed to investigate the relationship between these dietary components and their implication for simultaneously achieving recommended daily dietary intakes in individuals with hypertension. Methods: Data on hypertensive adults was pooled from ten National Health and Nutrition Examination Surveys (1999 - 2020) and weighted to provide national estimates. Dietary electrolyte intake was stratified as: 1) sodium ≤ 2300 mg/d [recommended] or ≤ 3000 mg/d [adequate], and 2) potassium > 4700 mg/d [recommended] or 3400 mg/d (men) and > 2600 mg/d (women) [adequate]. Results: Few hypertensives met recommended intakes of sodium (25.7%) and potassium (6.4%) with virtually none meeting both levels (0.1%). Fewer individuals met potassium recommendations after the 2015 Dietary Guidelines for Americans were made (2015-2020 vs. earlier, p =0.006) with those meeting recommended sodium remaining similar (p = 0.97). Meeting adequate intakes of sodium (44.1%), potassium (33.1%), and both intakes simultaneously (6.6%) was more common. The correlations between sodium and potassium, calories and sodium, and calories and potassium were 0.63, 0.77, and 0.74, respectively. However, individuals who met adequate potassium levels (and not sodium) had the highest calorie intake (median [IQR] = 2912 [2368, 3666]), with those meeting adequate sodium levels only having the lowest (1402 [1083, 1757]), and those who met neither intake (2254 [1854, 2717]) and those meeting both adequate intakes in between (1866 [1568, 2256], p < 0.001). Meeting adequate sodium only results in the lowest potassium intake (1680 mg [1241, 2152]), while meeting adequate potassium only results in the highest sodium intake (4801 mg [3840, 6215]). Conclusion: Hypertensives almost never meet both recommended intakes of sodium and potassium with higher intakes of potassium associated with high sodium and calories. Altering contemporary diets to augment potassium while reducing sodium will require strategies that decouple the positive association of potassium with both sodium and calories.
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