Sodium, potassium, and calories: implications for implementing a recommended diet in adults with hypertension

Achieving evidence-based dietary recommendations for sodium and potassium are key lifestyle modifications for adults with hypertension. This study aimed to investigate how dietary recommendations have been followed in US adults with hypertension over time.

Cross-sectional data on adults with hypertension was pooled from 12 National Health and Nutrition Examination Surveys (1999-2023). Dietary electrolyte intake was stratified as: (1) sodium ≤2300 mg/day (recommended) or ≤1500 mg/day (ideal), and (2) potassium ≥3500 mg/day (recommended) or ≥4700 mg/day (ideal).

From 1999 to 2023, 29.4% (95% confidence interval: 28.6-30.1) and 20.3% (19.6-21.0) of adults with hypertension met recommended sodium and potassium intakes, respectively, with 1.3% (1.1-1.5) meeting both levels. Adults with hypertension meeting ideal intakes for sodium, potassium, and both represented 9.5% (9.1-10.0), 6.1% (5.7-6.6), and 0.03% (0.01-0.06), respectively. The proportion meeting recommended thresholds for sodium has followed a U-shape over time reaching a minimum [24.3% (21.6-26.9)] in 2011-12 before increasing to 34.5% (31.3-37.7) in 2021-23 (P < .001). The proportion meeting the recommended potassium intake, however, has declined over time [yearly prevalence ratio = 0.99 (0.98-0.99), P < .001] reaching the lowest point [15.3% (13.5-17.0)] in 2021-23. The correlations between intakes of sodium and potassium, calories and sodium, and calories and potassium were 0.62, 0.77, and 0.71, respectively.

A low percentage of adults with hypertension met both recommended sodium and potassium intakes with higher intakes of potassium associated with high sodium and calories.