Kidney Is Essential for Blood Pressure Modulation by Dietary Potassium
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HYPERTENSION (DS GELLER AND DL COHEN, SECTION EDITORS)
Kidney Is Essential for Blood Pressure Modulation by Dietary Potassium Xiao-Tong Su 1 & Chao-Ling Yang 1 & David H. Ellison 1,2,3
# The Author(s) 2020
Abstract Eating more potassium may reduce blood pressure and the occurrence of other cardiovascular diseases by actions on various systems, including the vasculature, the sympathetic nervous system, systemic metabolism, and body fluid volume. Among these, the kidney plays a major role in the potassium-rich diet–mediated blood pressure reduction. Purpose of Review To provide an overview of recent discoveries about the mechanisms by which a potassium-rich diet leads to natriuresis. Recent Findings Although the distal convoluted tubule (DCT) is a short part of the nephron that reabsorbs salt, via the sodiumchloride cotransporter (NCC), it is highly sensitive to changes in plasma potassium concentration. Activation or inhibition of NCC raises or lowers blood pressure. Recent work suggests that extracellular potassium concentration is sensed by the DCT via intracellular chloride concentration which regulates WNK kinases in the DCT. Summary High-potassium diet targets NCC in the DCT, resulting in natriuresis and fluid volume reduction, which are protective from hypertension and other cardiovascular problems. Keywords High-potassium diet . Blood pressure . Hypertension . Natriuresis . DCT . NCC
Introduction Hypertension is a worldwide health problem affecting 40% of the population over the age of 25 [1]. A new assessment by the Global Burden of Disease consortium indicates that unless better approaches can be devised, hypertension will remain the predominant factor contributing to risk-attributable years This article is part of the Topical Collection on Hypertension * David H. Ellison [email protected] Xiao-Tong Su [email protected] Chao-Ling Yang [email protected] 1
School of Medicine, Oregon Health and Science University, Portland, OR, USA
2
Oregon Clinical & Translational Research Institute, SN4N, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
3
Veterans Administration Portland Health Care System, Portland, OR, USA
of life lost in 2040 [2]. While multiple therapeutic strategies have been developed to treat hypertension, challenges still exist, with many patients remaining poorly controlled. High blood pressure usually does not cause symptoms, but it is one of the most common risk factors for non-communicable diseases and is a leading cause of healthy life loss, making it second to smoking as a preventable cause of mortality [3]. Hypertension is one of the strongest risk factors for cardiovascular diseases, including coronary disease, left ventricular hypertrophy, valvular heart disease, cardiac arrhythmias, cerebral stroke, and kidney failure. Lifestyle and nutrition are important factors that modulate blood pressure. Guideline-driven initial management of hypertension or pre-hypertension emphasizes non-pharmacological approaches, such as increasing physical activity
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