Urinary Potassium Excretion, Fibroblast Growth Factor 23, and Incident Hypertension in the General Population-Based PREVEND Cohort

Stanley M H Yeung,Joris I Rotmans,Ron T Gansevoort,Liffert Vogt,Ewout J Hoorn,Martin H De Borst,Stephan J L Bakker

doi:10.3390/nu13124532

Abstract

High plasma fibroblast growth factor 23 (FGF23) and low potassium intake have each been associated with incident hypertension. We recently demonstrated that potassium supplementation reduces FGF23 levels in pre-hypertensive individuals. The aim of the current study was to address whether 24-h urinary potassium excretion, reflecting dietary potassium intake, is associated with FGF23, and whether FGF23 mediates the association between urinary potassium excretion and incident hypertension in the general population. At baseline, 4194 community-dwelling individuals without hypertension were included. Mean urinary potassium excretion was 76 (23) mmol/24 h in men, and 64 (20) mmol/24 h in women. Plasma C-terminal FGF23 was 64.5 (54.2–77.8) RU/mL in men, and 70.3 (56.5–89.5) RU/mL in women. Urinary potassium excretion was inversely associated with FGF23, independent of age, sex, urinary sodium excretion, bone and mineral parameters, inflammation, and iron status (St. β −0.02, p < 0.05). The lowest sex-specific urinary potassium excretion tertile (HR 1.18 (95% CI 1.01–1.37)), and the highest sex-specific tertile of FGF23 (HR 1.17 (95% CI 1.01–1.37)) were each associated with incident hypertension, compared with the reference tertile. FGF23 did not mediate the association between urinary potassium excretion and incident hypertension. Increasing potassium intake, and reducing plasma FGF23 could be independent targets to reduce the risk of hypertension in the general population.

Highlights

Hypertension is a major modifiable risk factor for cardiovascular disease and premature death [1]
4194 participants who were non-hypertensive at baseline and had available urinary potassium excretion and plasma fibroblast growth factor 23 (FGF23) data were included
FGF23 according to sex-specific tertiles are shown in Table 1 and in Supplemental Table S1, respectively

Summary

Introduction

Hypertension is a major modifiable risk factor for cardiovascular disease and premature death [1]. Lifestyle interventions, including optimization of potassium intake, form an important strategy to prevent or control hypertension [2]. The World Health Organization endorses a minimal average intake of 90 mmol potassium every day; most individuals consuming a Western diet may not reach that amount [3,4]. Several observational studies have shown that low potassium intake is associated with hypertension [5,6,7]. Randomized controlled trials found that potassium supplementation reduces blood pressure [8], probably at least in part through stimulation of natriuresis [9]. A number of animal and human studies have shown that higher potassium intake may influence plasma phosphate and fibroblast growth factor

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