title: Urinary potassium excretion and risk of developing hypertension: the prevention of renal and vascular end-stage disease study.
abstract: Previous prospective cohort studies on the association between potassium intake and risk of hypertension have almost exclusively relied on self-reported dietary data, whereas repeated 24-hour urine excretions, as estimate of dietary uptake, may provide a more objective and quantitative estimate of this association. Risk of hypertension (defined as blood pressure ≥140/90 mm Hg or initiation of blood pressure-lowering drugs) was prospectively studied in 5511 normotensive subjects aged 28 to 75 years not using blood pressure-lowering drugs at baseline of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study. Potassium excretion was measured in two 24-hour urine specimens at baseline (1997-1998) and midway during follow-up (2001-2003). Baseline median potassium excretion was 70 mmol/24 h (interquartile range, 57-85 mmol/24 h), which corresponds to a dietary potassium intake of ≈91 mmol/24 h. During a median follow-up of 7.6 years (interquartile range, 5.0-9.3 years), 1172 subjects developed hypertension. The lowest sex-specific tertile of potassium excretion (men: <68 mmol/24 h; women: <58 mmol/24 h) had an increased risk of hypertension after multivariable adjustment (hazard ratio, 1.20; 95% confidence interval, 1.05-1.37), compared with the upper 2 tertiles (Pnonlinearity=0.008). The proportion of hypertension attributable to low potassium excretion was 6.2% (95% confidence interval, 1.7%-10.9%). No association was found between the sodium to potassium excretion ratio and risk of hypertension after multivariable adjustment. Low urinary potassium excretion was associated with an increased risk of developing hypertension. Dietary strategies to increase potassium intake to the recommended level of 90 mmol/d may have the potential to reduce the incidence of hypertension.
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
authors.forename: Lyanne M
authors.initials: LM
authors.lastname: Kieneker
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
authors.forename: Ron T
authors.initials: RT
authors.lastname: Gansevoort
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Mukamal
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: de Boer
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
authors.forename: Gerjan
authors.initials: G
authors.lastname: Navis
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.).
authors.forename: Stephan J L
authors.initials: SJ
authors.lastname: Bakker
authors.affiliation: From the Top Institute Food and Nutrition, Wageningen, The Netherlands (L.M.K., S.J.L.B., M.M.J.); Departments of Internal Medicine (L.M.K., R.T.G., G.N., S.J.L.B., M.M.J.) and Cardiology (R.A.d.B.), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands (L.M.K.); and Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (K.J.M.). mmjoosten@gmail.com.
authors.forename: Michel M
authors.initials: MM
authors.lastname: Joosten
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000503:physiopathology* / Q000517:prevention & control / Q000652:urine*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011188:Potassium / Q000652:urine*; D017419:Potassium, Dietary / Q000008:administration & dosage; D011446:Prospective Studies; D012307:Risk Factors; D012964:Sodium / Q000652:urine; D014652:Vascular Diseases / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D017419:Potassium, Dietary; D012964:Sodium; D011188:Potassium
keywords: diet; epidemiology; hypertension; potassium; primary prevention; risk factors; sodium