In a perspective paper published in The American Journal of Clinical Nutrition, a team of researchers and health experts calls for a ‘paradigm shift’ in how public health agencies address hypertension, which affects more than 1.28 billion adults worldwide and remains a leading driver of cardiovascular disease. The authors say high blood pressure can be controlled better with a strategy that combines boosting potassium intake with reducing sodium.
Potassium-rich foods include fruits, vegetables, legumes and dairy. Image credit: Jasmine Lin.
The World Health Organization (WHO) currently recommends adults consume less than 2,000 milligrams of sodium per day and more than 3,500 milligrams of potassium.
Yet global sodium intake averages roughly double that limit, while potassium intake in many countries falls well short of the target.
Most dietary sodium in wealthy nations comes not from the salt shaker at home but from food purchased outside it, particularly packaged and restaurant fare.
In their new paper, University of Vermont’s Professor Naomi Fukagawa and her colleagues argue that sodium reduction alone has proven difficult to sustain at a population level, hampered by consumers’ preference for salty flavors and the technical challenges of reformulating food.
Meanwhile, evidence for potassium’s independent role in controlling blood pressure has strengthened.
“Hypertension affects over 1.28 billion adults worldwide and is a leading risk factor for cardiovascular disease,” the researchers said.
“Excessive sodium intake and insufficient potassium consumption are major modifiable contributors to elevated blood pressure, leading the WHO to recommend sodium intake below 2,000 mg/d and potassium intake above 3,500 mg/d.”
“Importantly, hypertension is the driver of cardiovascular disease risk and not merely a marker of excess sodium intake.”
“Despite the current dietary guidelines, average sodium intake remains significantly above recommendations, whereas potassium intake is often far below optimal levels in both developed and developing nations.”
“Historically, sodium reduction has been the targeted strategy for public health interventions to reduce population blood pressure.”
“Food manufacturers have been using potassium chloride and other potassium-containing ingredients as a tool to reduce sodium over the years, but new understanding of potassium’s critical role and efficacy in reducing blood pressure calls for a paradigm shift to consider sodium and potassium together when developing recommendations.”
The scientists point to a biological mechanism known as the renal potassium switch, which governs how the kidneys balance sodium and potassium during urine formation.
This system evolved to help the body conserve scarce potassium, but works against modern diets that are high in sodium and low in potassium, inadvertently driving up blood pressure.
Clinical evidence adds weight to the argument: the China Salt Substitute and Stroke Study found that replacing a portion of dietary sodium chloride with a potassium-based salt substitute reduced both blood pressure and cardiovascular events.
Modeling from that and related research suggests much of the benefit came from the added potassium rather than the reduced sodium.
The authors propose several strategies going forward, including exploring sodium-to-potassium ratios as a target for food manufacturers reformulating products, expanding education campaigns that highlight potassium-rich foods such as fruits and vegetables, and pursuing policies to help lower-income households access more potassium-rich foods.
They also note that potassium-enriched salt substitutes could offer a practical near-term tool, though they caution the substitutes aren’t appropriate for people with advanced kidney disease or those on certain medications.
The authors acknowledge that firm dietary guidelines for potassium remain elusive; a 2019 report from the National Academies of Sciences, Engineering, and Medicine found that dose-response data on potassium were still insufficient to set formal targets for reducing chronic disease risk. But they argue that waiting for perfect data has already cost public health efforts momentum.
They conclude that dietary sodium reduction is a foundational strategy for hypertension prevention and management.
However, new evidence supports a broadening of the current approach that focuses solely on sodium reduction and provides equal emphasis on increasing potassium intake.
“It is time to view dietary interventions holistically because food components interact and physiology is integrative across systems,” Professor Fukagawa said.
“Growing evidence shows that increasing dietary potassium as well as reducing sodium intake work together to better manage hypertension.”
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Naomi K. Fukagawa et al. 2026. Rethinking the impact of dietary sodium and potassium on blood pressure to advance public health. The American Journal of Clinical Nutrition 124 (2): 101396; doi: 10.1016/j.ajcnut.2026.101396
