THE INTERPLAY OF SODIUM AND POTASSIUM IN BLOOD PRESSURE

REGULATION

SUBMITTED BY:

JUNALIE M. TAN

BSN-2B

SUBMITTED TO:

MRS. BITUIN M. JACOSALEM, RN, MAN, EMT

CLINICAL INSTRUCTOR
 S.Y. 2023-2024

ABSTRACT

Understanding the complexity relationship between sodium and potassium is essential for

unraveling the complexities of blood pressure regulation. Targeted interventions that promote a

balanced sodium-potassium ratio in the diet may hold promise in preventing and managing

hypertension, ultimately contributing to improved cardiovascular health. Based on the applied

methods, mechanisms and analysis, sodium, primarily obtained through dietary intake, is known

to raise blood pressure by increasing extracellular fluid volume. Excessive sodium intake

disrupts the delicate balance of fluid in the body, leading to increased blood volume and

pressure. On the other hand, potassium, which is mostly found in fruits and vegetables,

promotes urination and widening of blood vessels, which neutralizes the hypertensive effects of

sodium.

INTRODUCTION

Potassium and sodium are closely interconnected but have opposite effects in the body.

Both are essential nutrients that play key roles in maintaining physiological balance, and both

have been linked to the risk of chronic diseases, especially cardiovascular disease. High salt

intake increases blood pressure, which can lead to heart disease, while high potassium intake

can help relax blood vessels and excrete sodium while decreasing blood pressure. Our bodies

need far more potassium than sodium each day, Chan (2023). Also, sodium and potassium

intakes are factors known to influence blood pressure (BP) through different pathways. These

mechanisms likely result in differential effects on parameters characterizing BP.

Nevertheless, according to Robinson (2021), sodium has central roles in the regulation

of blood volume and blood pressure in humans, respectively. Sodium is ubiquitous in human
physiology, and is central to cellular signaling pathways in neuronal, cardiovascular, renal and

most other systems in the body. Individuals with heart failure and hypertension it is appropriate

to recommend less sodium intake than what the populous consumes. However, for other

individuals with orthostatic hypotension more dietary sodium can be beneficial for blood

pressure regulation. In fact, for many otherwise healthy people, changing sodium intake has no

influence on their resting blood pressure.

Moreover, potassium is found naturally in many foods and as a supplement. Its main role

in the body is to help maintain normal levels of fluid inside our cells. Sodium, its counterpart,

maintains normal fluid levels outside of cells. Potassium also helps muscles to contract and

supports normal blood pressure. Sodium is one of the major minerals, which our bodies need in

relatively larger amounts to keep healthy. We can find sodium naturally in a variety of foods, but

it’s often common that we have it as sodium chloride, also known as table salt. One of sodium’s

main functions is to balance the amount and distribution of water in our bodies, playing a key

role in the control of our blood pressure. According to Eufic (2021), sodium interacts with

chloride and potassium in helping to regulate the volume of water in the body and to support the

normal function of our muscle and nerve cells. Having the right balance of these three minerals

in our diets particularly by making sure we eat enough potassium and keep our salt intake within

the recommended values is key to support a healthy blood pressure. Also, an adequate intake

of potassium is desirable to achieve a lower BP level but suggest excessive potassium

supplementation should be avoided, particularly in specific subgroups. Health Direct (2023)

added that sodium is needed for the body to function, but too much is linked to high blood

pressure, which can lead to heart disease, stroke and chronic kidney disease.

Furthermore, potassium is a mineral that is essential for all of the body's functions. It

helps your nerves, muscles and heart to function well, and also helps move nutrients and waste

around your body's cells. Potassium supports normal blood pressure. It reduces the effect of
sodium on blood pressure. However, misbalancing of potassium can lead to health problems,

potassium deficiency, low potassium and high potassium which can lead to a serious and

potentially life-threatening condition, Health Direct (2023).

According to Morgan, et, al. (1984), increased sodium intake altered a number of factors

that control sodium transport across cell membranes. The changes are complex but suggest

that genetically inherited and environmentally caused defects are necessary to allow

hypertension to be expressed. Reduction of sodium intake reduced blood pressure in people

with mild hypertension. Nevertheless, potassium interacted with sodium to reduce the rise in

blood pressure caused by sodium. Sodium intake and blood pressure are linked by many

mechanisms. If the intake is excessive for that individual or if there are defective control

mechanisms, hypertension will result.

In global setting, modern societies, Western diets have led to a decrease in potassium

intake with reduced consumption of fruits and vegetables with a concomitant increase in sodium

consumption through increased consumption of processed foods. Consumption of white

vegetables is associated with decreased risk of stroke, possibly related to their high potassium

content. The primary health outcome used to evaluate potassium intakes was blood pressure,

Dietary Guidelines for Americans Advisory Committee (2010). Moreover, the benefits of dietary

potassium may be primarily through its effect on blood pressure. High dietary potassium is

associated with a decrease in blood pressure, particularly in the context of a high-sodium diet.

However, higher potassium: sodium intakes determined via urinary excretion rates have

stronger effects on blood pressure and the risk of subsequent cardiovascular disease than

either sodium or potassium alone.

In addition, Jackson (2018) stated the collected 24-hour urine samples and measured

urinary electrolytes among a representative sample of US adults age 20 to 69 years old has

urinary sodium and potassium excretion with blood pressure in the US population, unbiased by
self-report of food intake. Hypothesized that higher excreted sodium and sodium-to-potassium

ratio would be significantly associated with higher blood pressure and odds of hypertension, and

that higher potassium excretion would be inversely associated with blood pressure and odds of

hypertension.

Moreover, in the Philippines context, Antiola (2022) stated that potassium is an essential

mineral needed by all tissues in the body. It helps regulate fluid balance, muscle contraction,

and nerve signals. It also helps to ease tension in your blood vessel walls, which helps further

lower blood pressure. However, hypertension commonly known as high blood pressure in adults

is when you have elevated blood pressure or a blood pressure reading of more than 120/80

mmHg. When it comes to fighting high blood pressure, the average Filipino diet delivers too

much sodium and little potassium. Eating to reverse this imbalance could prevent or control high

blood pressure and translate into fewer heart attacks, strokes, and deaths from heart disease.

People are cautious with their taking on both sodium and potassium because both are

necessities for having a healthy lifestyle or body.

 REVIEW OF RELATED LITERATURE

Dietary interventions in particular those based on sodium or potassium intakes, have

demonstrated their ability to reduce blood pressure in humans. A U.S.-based multicenter

randomized controlled trial (RCT), showed that a high-potassium and high-calcium dietary

intervention was associated with significantly reduced mean blood pressure at low,

intermediate, and high sodium intakes compared with the control diet. According to (Perez, et.al,

2014), among the randomized controlled trials reviewed, the sodium-to-potassium ratio appears

to be more strongly associated with blood pressure outcomes than either sodium or potassium

alone in hypertensive adult populations. Evidently, the observational studies reviewed provide

additional support for the sodium-to-potassium ratio as a superior metric to either sodium or

potassium alone in the evaluation of blood pressure outcomes and incident hypertension.

In addition, the study shows, both high sodium and low potassium are associated with

hypertension among the participants ages12 to 14 years who participated in the National Health

and Nutrition Examination Survey from 1999 to 2012. In young adolescents, both excessive

sodium and limited potassium are associated with high systolic blood pressure, but the balance

between sodium and potassium intake may be more useful in explaining blood pressure in the

population (Chmielewski, 2017).

Moreover, Weaver (2013) stated that lower sodium intake resulted in lower levels of

blood pressure whereas higher potassium consumption was associated with a reduction in

blood pressure in hypertensive populations only. Several mechanisms exist by which sodium

and potassium can influence blood pressure, and evidence indicates that the interaction

between these nutrients plays a dominant role in the development of primary hypertension.

Specifically, diets characteristic of the modern Western diet which is high in sodium and low in
potassium produce a biologic interaction with the kidneys, resulting in excessive sodium and

insufficient potassium concentrations in the human body, these biologic changes result in

vascular smooth muscle cell contraction, followed by an increase in peripheral vascular

resistance and higher blood pressure, and finally hypertension.

Furthermore, the benefits of increased potassium and reduced sodium are incompletely

additive, sub additive, meaning that individuals consuming high amounts of sodium may

especially benefit from increasing potassium intakes. Also, the benefits of dietary potassium on

blood pressure are strongest in salt-sensitive individuals. Additionally, according to Weinberger

(1997), the epidemiologic evidence connecting sodium intake to blood pressure has often been

confounded by reciprocal changes in potassium intake. Societies in which sodium intake is

traditionally low typically have a high potassium intake, primarily from fruit and vegetables. On

the other hand, potassium intake tends to be reduced in societies where sodium intake is

increased. Thus, dietary potassium and sodium should be considered together for benefits to

blood pressure reduction.

According to Grillo, et.al (2019), excessive sodium consumption defined by the World

Health Organization as 5 g sodium per day has been shown to produce a significant increase in

BP and has been linked with onset of hypertension and its cardiovascular complications.

Conversely, reduction in sodium intake not only decreases BP levels and hypertension

incidence, but is also associated with a reduction in cardiovascular morbidity and mortality.

Evidently and according to the current views of Youssef (2022), excessive intake of sodium

defined by the World Health Organization [WHO] as more than 2 g of sodium or more than 5 g

of sodium chloride per day is directly linked to high blood pressure and it was found that the

higher the daily salt intake, the higher the systolic blood pressure. In addition, high salt intake

was found to blunt the physiologic nocturnal blood pressure dipping and to increase the daytime

heart rate in ambulatory blood pressure monitoring. Conversely, a reduction of dietary sodium or
salt intake can lead to not only a reduction in blood pressure, but also a reduction in

cardiovascular morbidity and mortality.

Filippini, et.al (2020) states that sodium plays a well-known role in blood pressure.

Generally, less known is the impact of potassium. This mineral is found in many foods that help

your muscles work, including muscles that control your heartbeat and breathing. Its levels in the

body are largely maintained by the kidneys. While too much sodium in your diet can increase

blood pressure, too little potassium can have the same effect. This is due to the effect

potassium has on sodium. The more potassium you eat, the more sodium you are able to

excrete in urine. In not consuming enough potassium, sodium is reabsorbed by the kidneys and

retained in the body. To this end, a high potassium intake helps keep the ratio of sodium to

potassium in balance, aiding in the control of hypertension.

According to Mount (2023), the level of potassium intake can affect blood pressure. The

effect varies with the direction of low potassium intake raises the blood pressure, and high

potassium intake lowers the blood pressure and magnitude of change in potassium intake.

Thus, low dietary potassium intake below 40 mEq/day, 1.5 g/day has been associated with an

elevation in blood pressure and an increased risk of stroke as well as an increase in risk of

chronic kidney disease. Evidently, studies have shown that potassium deficiency not only

increases blood pressure but increases the risk of heart attack and stroke as well. Getting

enough potassium may have the opposite effect.

In addition, Preuss (2020), recommend decreasing dietary intake of sodium from high–

sodium content foods and table salt while increasing potassium because such maneuvers

should enhance overall health. The sodium content of the body correlates directly with fluid

volume. However, many throughout the world unfortunately ingest far more sodium than

generally recommended, leading to volume expansion, edema, and elevate blood pressure. The

large INTERMAP and Dietary Approach to Stop Hypertension clinical investigations corroborate
findings from earlier studies like INTERSALT by concluding that higher sodium intakes cause

elevated blood pressure leading to many cardiovascular perturbations. On the other hand, too

small a circulating volume emanating from low sodium intake can create symptoms/signs

ranging from tiredness or low blood pressure to outright disorientation or shock. Conversely,

higher potassium intakes are characteristically associated with lower blood pressures and better

cardiovascular performance. Nevertheless, high and low circulating potassium can also have

profound adverse effects primarily on depolarization, contraction of the heart. With diminished

renal function, even moderate potassium intake can cause serious cardiovascular

complications.

According to Staruschenko (2018) stated that it is well recognized that higher levels of

sodium intake are associated with elevated BP. It was predicted more than a century ago that

the effect of sodium on BP is dependent on diet composition, specifically potassium content.

The interaction of sodium and natriuresis produced by potassium would lead to serious disease.

However, potassium and sodium chloride in humans should be lower to the elevated BP and the

hypertension is causes of the low-potassium diet and excess sodium chloride consumption.
 SUMMARY

Blood pressure regulation is a complex and closely regulated physiological mechanism

that involves the interaction of sodium and potassium. These two electrolytes are essential for

sustaining neuronal function, muscular contraction, and fluid balance all of which have an effect

on blood pressure. Potassium and sodium keep a careful equilibrium that is essential for

controlling blood pressure. Sodium, which is mostly found in salt, can raise blood pressure by

causing the blood to retain more fluid, which raises blood pressure. Through encouraging

sodium excretion and relaxing blood vessel walls, potassium, on the other hand, neutralizes the

effects of sodium and helps to lower blood pressure. Together, the effects of sodium and

potassium on blood volume and blood vessel tone help to control blood pressure. Consuming

potassium and sodium in moderation is crucial to preserving good cardiovascular health in

general. High-sodium, low-potassium diets may aggravate hypertension. Appropriate

consumption of foods high in potassium, like fruits and vegetables, in a well-balanced diet can

help maintain normal blood pressure levels.

 CONCLUSIONS

In conclusion, the interaction of sodium and potassium is a critical role in the regulation

of blood pressure, which is a critical aspect of cardiovascular health. The careful balance of

these two electrolytes regulates a variety of physiological processes that contribute to blood

pressure regulation.

Sodium, which is present primarily in extracellular fluid, influences blood pressure via

affecting fluid balance and causing vasoconstriction. Excessive sodium consumption is linked to

high blood pressure and can trigger additional factors that contribute to hypertension.

However, potassium, which is mostly found inside cells, neutralizes the effects of sodium. It

encourages vasodilation, aids in preserving the fluid balance inside cells, and inhibits factors

that lead to hypertension. By promoting sodium excretion and relaxing blood arteries, adequate

potassium levels help to reduce blood pressure. Dietary choices, including reducing sodium

intake and consuming potassium-rich foods, play a crucial role in supporting this balance.

Thus, creating plans to control and avoid hypertension requires a thorough grasp of the

interactions between sodium and potassium. A balanced diet and other lifestyle changes are

essential for preserving ideal blood pressure and lowering the risk of cardiovascular illnesses.

Understanding the significance of sodium chloride and potassium balance offers individuals and

healthcare professionals important new perspectives on how to support heart health and

general well-being.
 RECOMMENDATIONS

Effectively managing blood pressure involves making choices in our lives that take into

account the complex relationship, between sodium and potassium. To reduce the risk of

hypertension, it's important to prioritize lowering the sodium intake by avoiding processed and

fast foods that're usually high in sodium. At the time, everyone should make an effort to

increase potassium levels by consuming potassium rich foods like fruits, vegetables and

legumes. Following a balanced diet that includes dense foods such as whole grains and lean

proteins also contributes to maintaining overall cardiovascular health.

Being mindful of the information on food labels is crucial for monitoring and controlling

sodium intake while preparing meals at home gives everyone control over the ingredients they

use. It's also important to limit alcohol consumption, stay properly hydrated and incorporate

activity into daily routines as part of a healthy lifestyle. Regularly monitoring blood pressure is

especially important for those with risk factors for hypertension as it allows for detection and

intervention.

Seeking guidance from healthcare professionals helps ensure strategies that align with

our health needs. Additionally advocating for awareness and supportive policies aimed at

reducing sodium in processed foods can contribute to efforts in promoting heart healthy

practices. By embracing these recommendations, we can actively contribute to maintaining a

ratio of sodium, to potassium, which promotes regulation of blood pressure and sustains

cardiovascular well-being.
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