(Hypertension. 1999;33:18-23.)
© 1999 American Heart Association, Inc.
Scientific Contributions |
Normotensive Salt Sensitivity
Effects of Race and Dietary Potassium
From the Department of Medicine, General Clinical Research Center, University of California, San Francisco.
Correspondence to R. Curtis Morris, Jr, MD, General Clinical Research Center, University of California at San Francisco, 1202 Moffitt Hospital, San Francisco, CA 94143-0126. E-mail cmorris{at}gcrcmail.ucsf.edu
Abstract—Normotensive salt
sensitivity, a putative precursor of hypertension, might be quite
frequent in African Americans (blacks) and less frequent in Caucasian
Americans (whites), but only when dietary potassium is deficient and
not when maintained well within the normal range. We tested this
hypothesis in 41 metabolically controlled studies of 38
healthy normotensive men (24 blacks, 14 whites) who ate a basal diet
low in sodium (15 mmol/d) and marginally deficient in potassium
(30 mmol/d) for 6 weeks. Throughout the last 4 weeks, NaCl was
loaded (250 mmol/d); throughout the last 3, potassium was
supplemented (as potassium bicarbonate) to either mid- or high-normal
levels, 70 and 120 mmol/d. Salt sensitivity, defined as an
increase in mean arterial blood pressure 
3 mm Hg
with salt loading, was deemed "moderate" if increasing 
10
mm Hg and "severe" if increasing more. When dietary potassium was
30 mmol/d, salt loading induced a mean increase in blood pressure
only in blacks (P<0.001), and salt sensitivity occurred
in most blacks but not whites (79% vs 36% (P<0.02).
Supplementing potassium only to 70 mmol/d attenuated moderate salt
sensitivity similarly in blacks and whites; 120 mmol/d abolished
it, attenuated severe salt sensitivity, which occurred in a quarter of
affected blacks, and suppressed the frequency and severity of salt
sensitivity in blacks to levels similar to those observed in whites.
These observations demonstrate that in most normotensive black men but
not white men, salt sensitivity occurs when dietary potassium is even
marginally deficient but is dose-dependently suppressed when dietary
potassium is increased within its normal range. Such suppression might
prevent or delay the occurrence of hypertension, particularly in the
many blacks, in whom dietary potassium is deficient.
Key Words: sodium, sensitivity • potassium • hypertension • African Americans
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