Effect Of Increased Potassium Intake On Cardiovascular Risk Factors And Disease: Systematic Review And Meta
- Accepted 18 February 2013
Enalapril And A Potassium Interaction:
Q. My pharmacist said I could have killed myself if I kept taking potassium with my blood pressure medicine. My new doctor switched me to enalapril and didnt mention any precautions.
Before this I was on hydrochlorothiazide and potassium supplements. Its lucky my pharmacist noticed I had changed blood pressure prescriptions when I went to have the potassium refilled.
I have also used Lite Salt or NoSalt for years to reduce my sodium intake. Do I need to stop using the salt substitute as well?
A. Potassium-based salt substitutes like the ones you have been using can be a good way of cutting back on sodium and getting extra potassium. But in combination with medicines such as Vasotec , Capoten , Lotensin , Aceon , Accupril , Altace , Mavic , or Zestril , salt substitutes and potassium supplements could be disastrous. Too much potassium can cause fatal heart rhythms.
Data Extraction Risk Of Bias And Quality Assessment
Two reviewers independently extracted relevant population and intervention characteristics of each study by using a standard data extraction form. A third reviewer checked extracted data, and all disagreements were resolved through consensus. We requested any relevant missing information from the original study authors. In the case of duplicate publications and companion papers of a primary publication, we evaluated all available data to maximise the yield of information.
For randomised controlled trials, we assessed the risk of bias associated with the method of sequence generation , allocation concealment , blinding , selective reporting , loss to follow-up , and completeness of reporting outcome data . In cohort studies, we additionally evaluated the risk of bias associated with methods of measuring exposure , collecting outcome data , and selecting study participants . We rated the risk of bias as being low, unclear, or high according to established criteria.2527
We used funnel plots to assess for the presence of small study bias.2829 We generated risk of bias graph and risk of bias summary figures for each study type separately in adults and children. We used GRADEProfiler software to assess the quality of the body of evidence according to the methodology of grading of recommendations assessment, development, and evaluation .30
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How Much Potassium Do You Need To Lower Blood Pressure
For the average adult, a healthy potassium intake is between 3,500 and 4,700 milligrams per day. Unfortunately, the typical diet in the U.S. offers too much sodium and not enough potassium. The first step to decreasing your risk factors for hypertension is decreasing salty food intake and adding potassium-rich foods to your diet. It is a good idea to have your labs checked with your physician to see if you are deficient in potassium or have elevated levels, which can happen with chronic kidney disease.
How Can I Prevent Hyperkalemia
If youve had hyperkalemia or are at risk for it, a low-potassium diet is the best way to protect your health. You may need to cut back on, or completely cut out, certain high-potassium foods, such as:
- Asparagus.
- Citrus fruits and juices, such as oranges and grapefruit.
- Cooked spinach.
- Melons like honeydew and cantaloupe.
- Nectarines.
- Prunes, raisins and other dried fruits.
- Pumpkin and winter squash.
- Salt substitutes that contain potassium.
- Tomatoes and tomato-based products like sauces and ketchup.
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What Is High Potassium Or Hyperkalemia
Everyone needs potassium to survive. Potassium is a mineral and an electrolyte. It helps your muscles work, including the muscles that control your heartbeat and breathing. Potassium comes from the food you eat.
Your body uses the potassium it needs. The extra potassium that your body does not need is removed from your blood by your kidneys. When you have kidney disease, your kidneys cannot remove extra potassium in the right way, and too much potassium can stay in your blood.
When you have too much potassium in your blood, it is called high potassium, or hyperkalemia. Having too much potassium in your blood can be dangerous. High potassium can even cause a heart attack or death! Unfortunately, many people do not feel symptoms of high potassium until its too late and their heart health worsens.
What Questions Should I Ask My Doctor
If you have hyperkalemia , you may want to ask your healthcare provider:
- Why did I get hyperkalemia?
- How often should I get blood tests to check for hyperkalemia?
- How much potassium should I get in my daily diet?
- What foods or supplements should I avoid?
- What, if any, salt substitutes can I use?
- What are the treatment risks and side effects?
- Am I at risk for kidney failure or other problems due to hyperkalemia?
- What follow-up care do I need after treatment?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Because hyperkalemia rarely causes symptoms, you may be surprised when a blood test shows that your potassium levels are high. A low-potassium diet can protect your health. Your healthcare provider can determine how much potassium you need or connect you with a dietitian, if needed. A dietitian can help you create meal plans that ensure you get just the right amount of potassium in your diet. Your provider may also change your medications. Potassium levels that reach a dangerously high level can be life-threatening. If youre at risk for hyperkalemia, your provider will closely monitor your potassium levels.
Last reviewed by a Cleveland Clinic medical professional on 10/05/2020.
References
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What Is High Potassium
- High levels of potassium in the blood is unpredictable and can be life-threatening. It can cause serious heart problems and sudden death.1-3 There are often no warning signs, meaning a person can have high potassium without knowing it.4
- If symptoms do occur, they are often nonspecific such as heart palpitations, nausea, weakness, or paresthesia.5 Paresthesia is an abnormal sensation of tingling, numbness, or burning that is usually felt in the hands, feet, arms, or legs.
- Blood potassium > 5.0 indicates potassium imbalance.6 Arbitrary thresholds are used to indicate degree of severity, such as mild , moderate , and severe .5,7 Clinical severity is determined by the speed of onset, magnitude of the severity, and the development of clinical findings.4
- Hyperkalemia is further classified as chronic or acute.5 Acute hyperkalemia represents a single event, occurring over hours to days and usually requires emergency treatment. Chronic hyperkalemia develops over the course of weeks to months, may be persistent or develop periodically, and requires ongoing outpatient management.
- A person’s potassium levels can be easily checked with a simple blood test. The healthcare provider draws a small blood sample, and sends it to a laboratory for analysis. This is usually part of a routine blood test given during a physical exam. It is often performed as part of a basic metabolic panel, which checks for several conditions, including kidney function and diabetes.
Blood Pressure And Kimchi
The researchers found that for men, a poor potassium sodium ratio was strongly correlated with blood pressure. Dividing the participants into 5 groups, the researchers looked at sodium intake, potassium intake, and the sodium to potassium ratio. They also looked at fruit intake, fruit and non-pickled vegetable intake, and kimchies intake. They found a strong correlation with kimchi intake, and an inverse relation with fruit and non-pickled vegetables.
The study did not find any correlation for the women, though. However, in contrast to the men, the fruit intake of the women increased as their kimchi intake increased. With the men, fruit intake decreased as kimchi intake increased. So for the women, the potassium sodium ratio may not have varied as much as the researchers estimated.
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Overlooking The Potassium Interaction Was A Medical Mistake:
This was an example of a serious medical mistake. The new physician clearly did not take time to review all the prior medications that had been prescribed and notice the potassium interaction. People take potassium supplements to compensate for the depletion of potassium brought on by diuretics like hydrochlorothiazide or furosemide . But when the prescription was changed to the ACE inhibitor enalapril, the doctor should have been far more careful to check the medical records and ask about salt substitutes. Fortunately, the pharmacist saved the day .
Such mistakes are far more common than most people realize. Thats why we wrote Top Screwups Doctors Make and How to Avoid Them. It offers hundreds of questions to ask and tips to prevent this kind of potentially lethal error. In particular, there is information on common mistakes made with ACE inhibitors, diabetes drugs, hypothyroidism and heartburn. Heres a link to the Peoples Pharmacy Store if you would like a copy.
Which Medications Cause High Potassium Levels
Medications that sometimes cause high potassium levels include certain antibiotics, blood pressure medication and herbal supplements, explains WebMD. Other medications that increase the amount of potassium in the blood are heparin, potassium supplements, nonsteroidal anti-inflammatory drugs, potassium-sparing diuretics and azole antifungals.
Hyperkalemia is a medical term that describes high potassium levels, notes WebMD. Antibiotics that sometimes cause this include penicillin G and trimethoprim, and blood pressure medications include ACE inhibitors, angiotensin-receptor blockers and beta-blockers. Herbal supplements that sometimes cause hyperkalemia include Siberian ginseng, milkweed, lily of the valley, Hawthorne berries and dried toad skin.
The kidneys play a major role in potassium regulation, and kidney disease is the most common cause of hyperkalemia, according to WebMD. Aldosterone regulates potassium removal from the kidneys, and diseases that reduce the production of this hormone cause hyperkalemia. Other causes of high potassium include hemolysis, rhabdomyolysis, burns, trauma and uncontrolled diabetes. These conditions cause the release of potassium from the cells into the bloodstream.
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Low Potassium Linked To High Blood Pressure
- Date:
- American Society of Nephrology
- Summary:
- As a risk factor for high blood pressure, low levels of potassium in the diet may be as important as high levels of sodium — especially among African-Americans, according to new research.
As a risk factor for high blood pressure, low levels of potassium in the diet may be as important as high levels of sodiumespecially among African Americans, according to research being presented at the American Society of Nephrology’s 41st Annual Meeting and Scientific Exposition in Philadelphia, Pennsylvania.
“There has been a lot of publicity about lowering salt or sodium in the diet in order to lower blood pressure, but not enough on increasing dietary potassium,” comments lead author Susan Hedayati, MD, of the University of Texas Southwestern Medical Center in Dallas, Texas, and the Dallas VA Medical Center.
The new study suggests that low potassium may be a particularly important contributor to high blood pressure among African Americans, and also identifies a gene that may influence potassium’s effects on blood pressure.
The relationship between low potassium and high blood pressure remained significant even when age, race, and other cardiovascular risk factorsincluding high cholesterol, diabetes, and smokingwere taken into account.
Research performed in the laboratory of Dr. Chou-Long Huang, a co-author of this study, has found evidence that a specific gene, called WNK1, may be responsible for potassium’s effects on blood pressure.
How Does Hyperkalemia Affect The Body
Potassium is a mineral that is crucial for normal cell function in the body, including heart muscle cells. The body gets potassium through foods.
The right level of potassium is key. The kidneys are primarily responsible for maintaining the bodys total potassium content by balancing potassium intake with potassium excretion. If intake of potassium far outweighs the kidneys ability to remove it, or if kidney function decreases, there can be too much potassium and hyperkalemia may occur.
Potassium and sodium concentrations play a crucial role in electric signal functioning of the hearts middle thick muscle layer, known as the myocardium. An above normal level of potassium can interfere with proper electric signals in that muscle layer and lead to different types of heart arrhythmias.
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Can It Be Prevented
Dietary changes can help prevent and treat high potassium levels. Talk to your doctor to understand any risk you might have for hyperkalemia. Your doctor may recommend foods that you may need to limit or avoid. These may include:
- asparagus, avocados, potatoes, tomatoes or tomato sauce, winter squash, pumpkin, cooked spinach
- oranges and orange juice, nectarines, kiwifruit, bananas, cantaloupe, honeydew, prunes and raisins or other dried fruit.
If you are on a low-salt diet, avoid taking salt substitutes.
Hyperkalemia And Potassium Shifts
Potassium can move out of and into cells. Our total body potassium stores are approximately 50 mEq/kg of body weight. At any given time, about 98% of the total potassium in the body is located inside of cells , with only 2% located outside of cells . The blood tests for measurement of potassium levels measure only the potassium that is outside of the cells. Therefore, conditions that can cause potassium to move out of the cells into the blood circulation can increase the blood potassium levels even though the total amount of potassium in the body has not changed.
One example of potassium shift causing hyperkalemia is diabetic ketoacidosis. Insulin is vital to patients with type 1 diabetes. Without insulin, patients with type 1 diabetes can develop severely elevated blood glucose levels. Lack of insulin also causes the breakdown of fat cells, with the release of ketones into the blood, turning the blood acidic . The acidosis and high glucose levels in the blood work together to cause fluid and potassium to move out of the cells into the blood circulation. Patients with diabetes often also have diminished kidney capacity to excrete potassium into urine. The combination of potassium shift out of cells and diminished urine potassium excretion causes hyperkalemia.
Another cause of hyperkalemia is tissue destruction, dying cells release potassium into the blood circulation. Examples of tissue destruction causing hyperkalemia include:
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Effects On Your Kidneys
High potassium doesnt cause kidney conditions, but its generally directly related to your kidneys. You may be more susceptible to high potassium if you have kidney failure or another kidney condition. Thats because your kidneys are meant to balance the potassium levels in your body.
Your body absorbs potassium through foods, drinks, and sometimes supplements. Your kidneys excrete leftover potassium through your urine. But if your kidneys arent working as they should, your body may not be able to remove extra potassium.
High potassium may also cause other symptoms and effects. This includes:
- abdominal conditions, including nausea, vomiting, diarrhea, and cramping
- numbness or tingling in your arms, hands, legs, or feet
- changes in mood, such as irritability
- muscle weakness
These symptoms may slowly develop in your body and be so mild that you dont even notice them. Subtle symptoms could make it difficult to diagnose high potassium. Its important to see your doctor for routine bloodwork on a regular basis.
Potassium And Your Nerves And Brain
Potassium helps your nerves fire properly so that they respond to stimulation. Again, this happens via electrical signals that travel from cell to cell.
As part of the nervous system, your brain also needs potassium. The mineral allows brain cells to communicate, both with each other and with cells that are farther away. Changes in potassium levels have been linked to learning, the release of hormones, and metabolism.
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How Does Potassium Lower Blood Pressure
Potassium and blood pressure have an inverse relationship to one another. Patients with elevated potassium have lower blood pressure, and patients who have low potassium have an elevated blood pressure, says Craig Beavers, Pharm.D., a member of the American College of Cardiology s Cardiovascular Team Section and Leadership Council and director of cardiovascular services at Baptist Health Paducah. Why? It has to do with the relationship between electrolytes and fluid in your body.
Potassium, sodium, and magnesium are all examples of electrolytes that help maintain the proper fluid and blood volume balance in your body. The role of sodium in high blood pressure is well-known. Too much salt can result in elevated blood pressure in susceptible individuals. Low potassium intake can have the same effect.
Thats because potassium helps kick sodium out of your system. The more potassium you eat, the more sodium you lose through your urine, according to the American Heart Association. If youve got a lot of sodium in your system, it can lead to fluid retention and that makes your heart work harder because theres more fluid to push around. That harder work raises your blood pressure and increases your risk for cardiovascular disease.
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Potassium And Your Diet
The recommended potassium intake for an average adult is 4,700 milligrams per day.
Many of the elements of the DASH diet fruits, vegetables, fat-free or low-fat dairy foods and fish are good natural sources of potassium. For example, a medium banana has about 420 mg of potassium and half a cup of plain mashed sweet potatoes has 475 mg.
Other potassium-rich foods include:
- Fat-free or low-fat milk
- Fat-free yogurt
- Grapefruit and grapefruit juice
- Greens
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