title: On the mechanism of the effects of potassium restriction on blood pressure and renal sodium retention.
abstract: Dietary potassium restriction increases sodium and chloride retention, whereas potassium administration promotes both diuresis and natriuresis. In epidemiologic and clinical studies, potassium intake is inversely related to blood pressure and is lower in blacks than in whites. The present studies examined the mechanism by which potassium restriction fosters sodium conservation and the impact of race on this response. Twenty-one healthy black and white men and women ingested an isocaloric, potassium-restricted diet (20 mmol/d) containing 180 mmol/d of sodium with and without a potassium supplement (80 mmol/d) for 9 days on two occasions. Additionally, eight of these subjects ingested the same diets for 3 days followed by a water load to determine free water clearance before and during the early phase of dietary potassium restriction. During potassium restriction, mean arterial pressure (MAP) derived from 24-hour blood pressure measurements was higher (85.7 +/- 1.6 mm Hg v 82.0 +/- 1.3 mm Hg; P < 0.001), cumulative sodium excretion lower (984 +/- 59 mmol/d v 1,256 +/- 58 mmol/d; P < 0.001), and weight greater (71.1 +/- 2.1 kg v 69.3 +/- 2.2 kg; P < 0.001). Blacks displayed no greater increase in MAP, although they excreted less sodium overall and less potassium on the potassium-supplemented diet. After a water load, minimum urine osmolality (Uosm) was lower (53.0 +/- 3.0 mOsm/L v 65.6 +/- 3.5 mOsm/L; P = 0.01) and free water clearance greater (4.44 +/- 0.59 mL/min v3.72 +/- 0.58 mL/min; P = 0.009) during potassium restriction. In conclusion, in healthy, normotensive subjects, potassium restriction was associated with an increase in blood pressure and volume expansion effected by increased renal sodium and chloride retention. Potassium restriction was also associated with increased free water clearance and enhanced diluting capacity consistent with augmentation of Na+, K+:2Cl- cotransporter activity in the thick ascending limb of Henle. This mechanism may play an important role in the renal adaptation required for potassium conservation, but at the expense of sodium chloride retention and an elevation in blood pressure.
authors.affiliation: Department of Medicine, Northwestern University Medical School, Chicago, IL, USA.
authors.forename: I W
authors.initials: IW
authors.lastname: Gallen
authors.forename: R M
authors.initials: RM
authors.lastname: Rosa
authors.forename: D Y
authors.initials: DY
authors.lastname: Esparaz
authors.forename: J B
authors.initials: JB
authors.lastname: Young
authors.forename: G L
authors.initials: GL
authors.lastname: Robertson
authors.forename: D
authors.initials: D
authors.lastname: Batlle
authors.forename: F H
authors.initials: FH
authors.lastname: Epstein
authors.forename: L
authors.initials: L
authors.lastname: Landsberg
mesh_terms: D000328:Adult; D044383:Black People; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D009318:Natriuresis / Q000502:physiology*; D011188:Potassium / Q000378:metabolism; D017419:Potassium, Dietary / Q000008:administration & dosage* / Q000494:pharmacology; D012964:Sodium / Q000378:metabolism; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage / Q000494:pharmacology; D014867:Water; D014882:Water-Electrolyte Balance / Q000502:physiology*; D044465:White People
chemical_list: D017419:Potassium, Dietary; D017673:Sodium Chloride, Dietary; D014867:Water; D012964:Sodium; D011188:Potassium