Potassium-Enriched Salt to Lower Stroke Risk: A #NephJC Editorial on the SSaSS Study

#NephJC is a recurring twitter-based journal club. #NephJC editorials highlight the discussed article and summarize key points from the NephJC TweetChat.BackgroundThe prevalence of hypertension has increased substantially over time, even after adjusting for age, and so have the associated disabilities and deaths.1Forouzanfar M.H. Liu P. Roth G.A. et al.Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015.JAMA. 2017; 317: 165-182Crossref PubMed Scopus (1083) Google Scholar Based on physiology principles and epidemiological studies, high sodium intake has been recognized as a key contributor to high blood pressure (BP). Previous randomized controlled trials (RCTs) have demonstrated that lowering sodium intake to <2 g/d versus maintaining sodium levels at ≥2 g/d reduces BP by about 3.5/1.8 mm Hg.2Aburto N.J. Ziolkovska A. Hooper L. Elliott P. Cappuccio F.P. Meerpohl J.J. Effect of lower sodium intake on health: systematic review and meta-analyses.BMJ. 2013; 346: f1326Crossref PubMed Scopus (817) Google Scholar Another meta-analysis showed that for every 50 mmol (∼1.15 g of sodium) decrease in 24-hour sodium excretion, the BP was lowered by 1.1/0.3 mm Hg.3Huang L. Trieu K. Yoshimura S. et al.Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials.BMJ. 2020; 368: m315Crossref PubMed Scopus (111) Google Scholar However, whether reducing sodium intake decreases adverse clinical outcomes is uncertain because RCTs have not had adequate power or longer-term follow-up to assess the effects on morbidity and mortality.Another important issue in the landscape of salt in hypertension is the effect of potassium intake on BP. Potassium lowers BP via multiple mechanisms, by acting directly on the vasculature and by triggering a signaling cascade mediated by With-no-lysine kinases that activates a “switch” to reduce sodium absorption.4Welling P.A. Roles and regulation of renal K channels.Annu Rev Physiol. 2016; 78: 415-435Crossref PubMed Scopus (66) Google Scholar Furthermore, a meta-analysis of 21 RCTs reported that increasing potassium intake lowers BP (∼3.5/2.0 mm Hg decrease) and the risk of stroke.5Aburto N.J. Hanson S. Gutierrez H. Hooper L. Elliott P. Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses.BMJ. 2013; 346: f1378Crossref PubMed Scopus (523) Google Scholar Notably, although there was no gradient for the effect of achieved potassium intake (which was ∼30-60 mmol/d higher) and BP, there was an interaction with sodium intake.5Aburto N.J. Hanson S. Gutierrez H. Hooper L. Elliott P. Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses.BMJ. 2013; 346: f1378Crossref PubMed Scopus (523) Google Scholar From the Dietary Approach to Stop Hypertension-Sodium trial, it was noted that increasing potassium intake was more effective at reducing BP with high sodium intake (5.9/2.9 mm Hg reduction) than with low sodium intake (2.2/1.0 mm Hg reduction).6Sacks F.M. Svetkey L.P. Vollmer W.M. et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10Crossref PubMed Scopus (3896) Google ScholarAlthough both sodium reduction and potassium supplementation have been studied in RCTs, the feasibility of implementation of these interventions has not been well established. In most trials of sodium reduction, including the Dietary Approach to Stop Hypertension-Sodium trial, the participants received packaged meals, thus representing feeding trials that are not feasible for routine practice.6Sacks F.M. Svetkey L.P. Vollmer W.M. et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10Crossref PubMed Scopus (3896) Google Scholar, 7Hiremath S. Towards better blood pressure: do non-pharmacological strategies provide the right path?.J Clin Hypertens (Greenwich). 2018; 20: 528-531Crossref PubMed Scopus (2) Google Scholar, 8Ruzicka M. Hiremath S. Steiner S. et al.What is the feasibility of implementing effective sodium reduction strategies to treat hypertension in primary care settings? A systematic review.J Hypertens. 2014; 32: 1388-1394Crossref PubMed Scopus (16) Google Scholar Additionally, the source and amount of sodium intake consumed vary across the world. A systematic review reported that Americans consume 3,400 mg (147 mEq) per day, whereas the residents of Northern China consume >11,000 mg (480 mEq) per day.9Bhat S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar,10Brown I.J. Tzoulaki I. Candeias V. Elliott P. Salt intakes around the world: implications for public health.Int J Epidemiol. 2009; 38: 791-813Crossref PubMed Scopus (818) Google Scholar Importantly, in China, that sodium intake is dominated by the salt added while cooking in the household, whereas it is dominated by and in S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google in of the sodium is by an for implementing a low sodium and high potassium have been demonstrated to lower BP have not been to the effect on clinical Marklund M. et salt as a to lower blood pressure: and 2020; PubMed Scopus Google Scholar, A. V. et al.Effect of salt on blood pressure and hypertension Med. 2020; PubMed Scopus Google Scholar, et al.Effects of a salt on blood pressure in a controlled J Clin Nutr. PubMed Scopus (16) Google Scholar Salt and randomized to salt sodium or a salt of sodium and potassium with the primary the of et for the and of high blood pressure in a of the of on 2018; PubMed Scopus Google Salt and was a that in in of from to from and for was the salt whereas the was to In the was randomized to the salt or thus the issue of of the to as well as it a for had had a than and had controlled controlled hypertension was as a systolic BP of mm Hg on or mm Hg not on had to for more than or most of the primary was and the outcomes adverse cardiovascular and from randomized to the and participants to the of the participants was with of of participants had a of and at least 24-hour sodium and potassium g and g the of the as in a of the sodium was by mmol and potassium was increased by mmol in the to the was by a BP reduction of mm Hg at the of the in the with the A with to the primary was demonstrated in the with a risk for of was across the adverse cardiovascular and lower in the salt In of adverse there was no in across the with a risk of the there participants and was noted that salt has had an important in from the of the and and the of the and to salt in a in the Salt has been as a for and as a source of that the source of sodium in added in the or in the by the of the in the it was noted that it is to the of to with lower levels of dietary salt than in China, the sodium intake is >11,000 mg (480 S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar and the sodium intake to lower levels of <2 g/d et for the and of high blood pressure in a of the of on 2018; PubMed Scopus Google sodium intake for and Scholar However, participants that the was to because with with high sodium of the reduction of sodium intake at about mmol/d from the mmol/d was with a intake of about mmol/d or g/d In the in potassium intake from a of mmol/d to mmol/d a about the of and whether it was mediated by sodium or potassium In the decrease in BP mm participants whether of BP reduction, even at a the clinical of as reported in the was not the that was with the of salt because of the of of potassium and the of participants with was not in the the issue of increased potassium intake to the in the of implementation of in the was noted that increased potassium intake not because of the A has demonstrated the of a salt in with S. et on the effects of dietary potassium on blood pressure and potassium levels in with PubMed Scopus Google Scholar Additionally, a of the of a salt in the more on and for and of and for the of an for potassium in Scholar risk in reported that in an in in there an reduction in because of a reduction in cardiovascular more from from cardiovascular M. et and in China of lowering sodium potassium salt 2020; PubMed Scopus Google Scholar Additionally, the an of a salt in the and for and of and for the of an for potassium in ScholarAlthough most participants that the key with to the of the In salt are and the In the sodium is added in implementation at that to from the with the and in to potassium to as and from the that salt in achieved while maintaining and for and of and for the of an for potassium in of to reduce salt reduction for the A. the do in Scholar across in the Salt and to in sodium and potassium intake on on the that and about and in the #NephJC is a recurring twitter-based journal club. #NephJC editorials highlight the discussed article and summarize key points from the NephJC #NephJC is a recurring twitter-based journal club. #NephJC editorials highlight the discussed article and summarize key points from the NephJC #NephJC is a recurring twitter-based journal club. #NephJC editorials highlight the discussed article and summarize key points from the NephJC prevalence of hypertension has increased substantially over time, even after adjusting for age, and so have the associated disabilities and deaths.1Forouzanfar M.H. Liu P. Roth G.A. et al.Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015.JAMA. 2017; 317: 165-182Crossref PubMed Scopus (1083) Google Scholar Based on physiology principles and epidemiological studies, high sodium intake has been recognized as a key contributor to high blood pressure (BP). Previous randomized controlled trials (RCTs) have demonstrated that lowering sodium intake to <2 g/d versus maintaining sodium levels at ≥2 g/d reduces BP by about 3.5/1.8 mm Hg.2Aburto N.J. Ziolkovska A. Hooper L. Elliott P. Cappuccio F.P. Meerpohl J.J. Effect of lower sodium intake on health: systematic review and meta-analyses.BMJ. 2013; 346: f1326Crossref PubMed Scopus (817) Google Scholar Another meta-analysis showed that for every 50 mmol (∼1.15 g of sodium) decrease in 24-hour sodium excretion, the BP was lowered by 1.1/0.3 mm Hg.3Huang L. Trieu K. Yoshimura S. et al.Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials.BMJ. 2020; 368: m315Crossref PubMed Scopus (111) Google Scholar However, whether reducing sodium intake decreases adverse clinical outcomes is uncertain because RCTs have not had adequate power or longer-term follow-up to assess the effects on morbidity and mortality.Another important issue in the landscape of salt in hypertension is the effect of potassium intake on BP. Potassium lowers BP via multiple mechanisms, by acting directly on the vasculature and by triggering a signaling cascade mediated by With-no-lysine kinases that activates a “switch” to reduce sodium absorption.4Welling P.A. Roles and regulation of renal K channels.Annu Rev Physiol. 2016; 78: 415-435Crossref PubMed Scopus (66) Google Scholar Furthermore, a meta-analysis of 21 RCTs reported that increasing potassium intake lowers BP (∼3.5/2.0 mm Hg decrease) and the risk of stroke.5Aburto N.J. Hanson S. Gutierrez H. Hooper L. Elliott P. Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses.BMJ. 2013; 346: f1378Crossref PubMed Scopus (523) Google Scholar Notably, although there was no gradient for the effect of achieved potassium intake (which was ∼30-60 mmol/d higher) and BP, there was an interaction with sodium intake.5Aburto N.J. Hanson S. Gutierrez H. Hooper L. Elliott P. Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses.BMJ. 2013; 346: f1378Crossref PubMed Scopus (523) Google Scholar From the Dietary Approach to Stop Hypertension-Sodium trial, it was noted that increasing potassium intake was more effective at reducing BP with high sodium intake (5.9/2.9 mm Hg reduction) than with low sodium intake (2.2/1.0 mm Hg reduction).6Sacks F.M. Svetkey L.P. Vollmer W.M. et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10Crossref PubMed Scopus (3896) Google ScholarAlthough both sodium reduction and potassium supplementation have been studied in RCTs, the feasibility of implementation of these interventions has not been well established. In most trials of sodium reduction, including the Dietary Approach to Stop Hypertension-Sodium trial, the participants received packaged meals, thus representing feeding trials that are not feasible for routine practice.6Sacks F.M. Svetkey L.P. Vollmer W.M. et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10Crossref PubMed Scopus (3896) Google Scholar, 7Hiremath S. Towards better blood pressure: do non-pharmacological strategies provide the right path?.J Clin Hypertens (Greenwich). 2018; 20: 528-531Crossref PubMed Scopus (2) Google Scholar, 8Ruzicka M. Hiremath S. Steiner S. et al.What is the feasibility of implementing effective sodium reduction strategies to treat hypertension in primary care settings? A systematic review.J Hypertens. 2014; 32: 1388-1394Crossref PubMed Scopus (16) Google Scholar Additionally, the source and amount of sodium intake consumed vary across the world. A systematic review reported that Americans consume 3,400 mg (147 mEq) per day, whereas the residents of Northern China consume >11,000 mg (480 mEq) per day.9Bhat S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar,10Brown I.J. Tzoulaki I. Candeias V. Elliott P. Salt intakes around the world: implications for public health.Int J Epidemiol. 2009; 38: 791-813Crossref PubMed Scopus (818) Google Scholar Importantly, in China, that sodium intake is dominated by the salt added while cooking in the household, whereas it is dominated by and in S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google in of the sodium is by an for implementing a low sodium and high potassium have been demonstrated to lower BP have not been to the effect on clinical Marklund M. et salt as a to lower blood pressure: and 2020; PubMed Scopus Google Scholar, A. V. et al.Effect of salt on blood pressure and hypertension Med. 2020; PubMed Scopus Google Scholar, et al.Effects of a salt on blood pressure in a controlled J Clin Nutr. PubMed Scopus (16) Google Scholar Salt and randomized to salt sodium or a salt of sodium and potassium with the primary the of et for the and of high blood pressure in a of the of on 2018; PubMed Scopus Google Scholar prevalence of hypertension has increased substantially over time, even after adjusting for age, and so have the associated disabilities and deaths.1Forouzanfar M.H. Liu P. Roth G.A. et al.Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015.JAMA. 2017; 317: 165-182Crossref PubMed Scopus (1083) Google Scholar Based on physiology principles and epidemiological studies, high sodium intake has been recognized as a key contributor to high blood pressure (BP). Previous randomized controlled trials (RCTs) have demonstrated that lowering sodium intake to <2 g/d versus maintaining sodium levels at ≥2 g/d reduces BP by about 3.5/1.8 mm Hg.2Aburto N.J. Ziolkovska A. Hooper L. Elliott P. Cappuccio F.P. Meerpohl J.J. Effect of lower sodium intake on health: systematic review and meta-analyses.BMJ. 2013; 346: f1326Crossref PubMed Scopus (817) Google Scholar Another meta-analysis showed that for every 50 mmol (∼1.15 g of sodium) decrease in 24-hour sodium excretion, the BP was lowered by 1.1/0.3 mm Hg.3Huang L. Trieu K. Yoshimura S. et al.Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials.BMJ. 2020; 368: m315Crossref PubMed Scopus (111) Google Scholar However, whether reducing sodium intake decreases adverse clinical outcomes is uncertain because RCTs have not had adequate power or longer-term follow-up to assess the effects on morbidity and Another important issue in the landscape of salt in hypertension is the effect of potassium intake on BP. Potassium lowers BP via multiple mechanisms, by acting directly on the vasculature and by triggering a signaling cascade mediated by With-no-lysine kinases that activates a “switch” to reduce sodium absorption.4Welling P.A. Roles and regulation of renal K channels.Annu Rev Physiol. 2016; 78: 415-435Crossref PubMed Scopus (66) Google Scholar Furthermore, a meta-analysis of 21 RCTs reported that increasing potassium intake lowers BP (∼3.5/2.0 mm Hg decrease) and the risk of stroke.5Aburto N.J. Hanson S. Gutierrez H. Hooper L. Elliott P. Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses.BMJ. 2013; 346: f1378Crossref PubMed Scopus (523) Google Scholar Notably, although there was no gradient for the effect of achieved potassium intake (which was ∼30-60 mmol/d higher) and BP, there was an interaction with sodium intake.5Aburto N.J. Hanson S. Gutierrez H. Hooper L. Elliott P. Cappuccio F.P. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses.BMJ. 2013; 346: f1378Crossref PubMed Scopus (523) Google Scholar From the Dietary Approach to Stop Hypertension-Sodium trial, it was noted that increasing potassium intake was more effective at reducing BP with high sodium intake (5.9/2.9 mm Hg reduction) than with low sodium intake (2.2/1.0 mm Hg reduction).6Sacks F.M. Svetkey L.P. Vollmer W.M. et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10Crossref PubMed Scopus (3896) Google Scholar both sodium reduction and potassium supplementation have been studied in RCTs, the feasibility of implementation of these interventions has not been well established. In most trials of sodium reduction, including the Dietary Approach to Stop Hypertension-Sodium trial, the participants received packaged meals, thus representing feeding trials that are not feasible for routine practice.6Sacks F.M. Svetkey L.P. Vollmer W.M. et al.Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group.N Engl J Med. 2001; 344: 3-10Crossref PubMed Scopus (3896) Google Scholar, 7Hiremath S. Towards better blood pressure: do non-pharmacological strategies provide the right path?.J Clin Hypertens (Greenwich). 2018; 20: 528-531Crossref PubMed Scopus (2) Google Scholar, 8Ruzicka M. Hiremath S. Steiner S. et al.What is the feasibility of implementing effective sodium reduction strategies to treat hypertension in primary care settings? A systematic review.J Hypertens. 2014; 32: 1388-1394Crossref PubMed Scopus (16) Google Scholar Additionally, the source and amount of sodium intake consumed vary across the world. A systematic review reported that Americans consume 3,400 mg (147 mEq) per day, whereas the residents of Northern China consume >11,000 mg (480 mEq) per day.9Bhat S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar,10Brown I.J. Tzoulaki I. Candeias V. Elliott P. Salt intakes around the world: implications for public health.Int J Epidemiol. 2009; 38: 791-813Crossref PubMed Scopus (818) Google Scholar Importantly, in China, that sodium intake is dominated by the salt added while cooking in the household, whereas it is dominated by and in S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar Salt in of the sodium is by an for implementing a low sodium and high potassium have been demonstrated to lower BP have not been to the effect on clinical Marklund M. et salt as a to lower blood pressure: and 2020; PubMed Scopus Google Scholar, A. V. et al.Effect of salt on blood pressure and hypertension Med. 2020; PubMed Scopus Google Scholar, et al.Effects of a salt on blood pressure in a controlled J Clin Nutr. PubMed Scopus (16) Google Scholar Salt and randomized to salt sodium or a salt of sodium and potassium with the primary the of et for the and of high blood pressure in a of the of on 2018; PubMed Scopus Google Scholar Salt and was a that in in of from to from and for was the salt whereas the was to In the was randomized to the salt or thus the issue of of the to as well as it a for had had a than and had controlled controlled hypertension was as a systolic BP of mm Hg on or mm Hg not on had to for more than or most of the primary was and the outcomes adverse cardiovascular and from randomized to the and participants to the of the participants was with of of participants had a of and at least 24-hour sodium and potassium g and g the of the as in a of the sodium was by mmol and potassium was increased by mmol in the to the was by a BP reduction of mm Hg at the of the in the with the A with to the primary was demonstrated in the with a risk for of was across the adverse cardiovascular and lower in the salt In of adverse there was no in across the with a risk of Salt and was a that in in of from to from and for was the salt whereas the was to In the was randomized to the salt or thus the issue of of the to as well as it a for had had a than and had controlled controlled hypertension was as a systolic BP of mm Hg on or mm Hg not on had to for more than or most of the primary was and the outcomes adverse cardiovascular and from randomized to the and participants to the of the participants was with of of participants had a of and at least 24-hour sodium and potassium g and g the of the as in a of the sodium was by mmol and potassium was increased by mmol in the to the was by a BP reduction of mm Hg at the of the in the with the A with to the primary was demonstrated in the with a risk for of was across the adverse cardiovascular and lower in the salt In of adverse there was no in across the with a risk of the there participants and was noted that salt has had an important in from the of the and and the of the and to salt in a in the Salt has been as a for and as a source of that the source of sodium in added in the or in the by the of the in the it was noted that it is to the of to with lower levels of dietary salt than in China, the sodium intake is >11,000 mg (480 S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar and the sodium intake to lower levels of <2 g/d et for the and of high blood pressure in a of the of on 2018; PubMed Scopus Google sodium intake for and Scholar However, participants that the was to because with with high sodium of the reduction of sodium intake at about mmol/d from the mmol/d was with a intake of about mmol/d or g/d In the in potassium intake from a of mmol/d to mmol/d a about the of and whether it was mediated by sodium or potassium In the decrease in BP mm participants whether of BP reduction, even at a the clinical of as reported in the was not the that was with the of salt because of the of of potassium and the of participants with was not in the the issue of increased potassium intake to the in the of implementation of in the was noted that increased potassium intake not because of the A has demonstrated the of a salt in with S. et on the effects of dietary potassium on blood pressure and potassium levels in with PubMed Scopus Google Scholar Additionally, a of the of a salt in the more on and for and of and for the of an for potassium in Scholar risk in reported that in an in in there an reduction in because of a reduction in cardiovascular more from from cardiovascular M. et and in China of lowering sodium potassium salt 2020; PubMed Scopus Google Scholar Additionally, the an of a salt in the and for and of and for the of an for potassium in ScholarAlthough most participants that the key with to the of the In salt are and the In the sodium is added in implementation at that to from the with the and in to potassium to as and from the that salt in achieved while maintaining and for and of and for the of an for potassium in of to reduce salt reduction for the A. the do in Scholar across in the Salt and to in sodium and potassium intake on the there participants and was noted that salt has had an important in from the of the and and the of the and to salt in a in the Salt has been as a for and as a source of that the source of sodium in added in the or in the by the of the in the it was noted that it is to the of to with lower levels of dietary salt than in China, the sodium intake is >11,000 mg (480 S. Marklund M. Henry M.E. et al.A systematic review of the sources of dietary salt around the world.Adv Nutr. 2020; 11: 677-686Crossref PubMed Scopus (64) Google Scholar and the sodium intake to lower levels of <2 g/d et for the and of high blood pressure in a of the of on 2018; PubMed Scopus Google sodium intake for and Scholar However, participants that the was to because with with high sodium of the reduction of sodium intake at about mmol/d from the mmol/d was with a intake of about mmol/d or g/d In the in potassium intake from a of mmol/d to mmol/d a about the of and whether it was mediated by sodium or potassium In the decrease in BP mm participants whether of BP reduction, even at a the clinical of as reported in the was not the that was with the of salt because of the of of potassium and the of participants with was not in the the issue of increased potassium intake to the in the of implementation of in the was noted that increased potassium intake not because of the A has demonstrated the of a salt in with S. et on the effects of dietary potassium on blood pressure and potassium levels in with PubMed Scopus Google Scholar Additionally, a of the of a salt in the more on and for and of and for the of an for potassium in Scholar risk in reported that in an in in there an reduction in because of a reduction in cardiovascular more from from cardiovascular M. et and in China of lowering sodium potassium salt 2020; PubMed Scopus Google Scholar Additionally, the an of a salt in the and for and of and for the of an for potassium in Scholar most participants that the key with to the of the In salt are and the In the sodium is added in implementation at that to from the with the and in to potassium to as and from the that salt in achieved while maintaining and for and of and for the of an for potassium in of to reduce salt reduction for the A. the do in Scholar across in the Salt and to in sodium and potassium intake on M. 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