Salt and Hypertension: ‘Switch’ing the Focus to Potassium

Dietary sodium reduction is the cornerstone of nonpharmacological modifications for lowering blood pressure (BP) in individuals with hypertension.1 In recent years, more attention has also focused on increasing dietary potassium and other micronutrients, such as with the Dietary Approach to Stop Hypertension (DASH) diet, which provides about 4,700mg (120mmol) of potassium in a day.2 The exact mechanism of the BP-lowering effect of potassium intake is being elucidated in the last decade or so, with an elegant body of research describing a “potassium switch” wherein high potassium intake inactivates the thiazide-sensitive sodium chloride cotransporter (NCC) via the with-no-lysine (WNK) and STE20/SPS1-related proline-alanine-rich protein kinase (SPAK) pathway to induce natriuresis and decrease BP.