Morris RC, Forman A, Sebastian A
Dietary potassium is more determining of salt- sensitivity in normotensive blacks than whites
12th Annual ASH Meeting
Am J Hypertens (Apr) 10:18A 1997

Background: Afro-Americans have previously been shown to be more frequently salt-sensitive than Caucasians. The etiology of this increased frequency of salt-sensitivity is not completely understood. Epidemiological studies have demonstrated that increased urinary sodium/potassium ratios are more tightly correlated to increases in blood pressure than urinary sodium excretion alone. The present study was undertaken to determine if potassium supplementation can modulate the sodium induced blood pressure increase in Afro-Americans as compared to Caucasian normotensive individuals.

Study: 24 Afro-Americans (AA) and 14 Caucasian (C) individuals were involved. Subjects received the following diets in sequence: Na 15 mmol, K 30 mmol for 11-14 days, followed by Na 250 mmol and K 30 mmol for 28 days. The final three weeks of high Na, Low K diet were supplemented with 40 or 90 mmol KHCO3.

Afro-American individuals demonstrated an increase in blood pressure with sodium loading [79% of the time vs. 39% in Caucasian individuals (P<0.02] and this was associated with greater positive sodium balance (P<0.05) in AA than in C. In Afro-Americans fed a high salt diet, blood pressure decreased in a sustained fashion after supplementation with 90 mmol KHCO3. Supplementation with the lower 40 mmol KHCO3 dose resulted in only transient blood pressure lowering effects. In the combined group of AA and C, during the high salt period, K supplementation resulted in blood pressure reduction that correlated with the amount of increase in urinary K excretion and serum K.

Comment: This study provides a number of important observations:
  1. Salt sensitive hypertension may be in part, ameliorated by potassium supplementation.
  2. Afro-Americans are more frequently salt sensitive than Caucasians.

The limitations of the study are based on the study design. Diets were not randomized or separated by a washout period. Very few salt sensitive Caucasians were identified to determine if salt-sensitivity per se rather than racial factors play a role in the benefits seen with potassium supplementation. Arlene Chapman, M.D., (University of Colorado, Denver)

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12th Annual ASH Meeting
H: Non drug therapy : Dietary/electrolyte therapy
H: Pathophysiology : Salt (sodium, chloride) sensitivity