Blood pressure control should focus on more potassium (2023) | Hacker News Reader

Blood pressure control should focus on more potassium (2023)

ahajournals.org

40 pointswill-burner43 comments

Long story, but if you are interested in potassium and high blood pressure, or if you have low potassium and high blood pressure, my story might be of interest to you.

At age 38 I was diagnosed with very high blood pressure. I had not been going to a doctor and was having headaches and bloody noses so it might have been going on for years. The first drug they put me on was a diuretic. They also put me on potassium after low potassium levels which is common with a diuretic.

Eventually, they also put me on a beta-blocker, a calcium channel blocker, and an ACE inhibitor. So I was getting all four BP meds and ended up at high or maximum doses. Around age 50 my potassium levels were getting very low and they kept increasing my potassium to no effect.

Primary care and cardiologist were flummoxed so they sent me for a kidney MRI. The radiologist looked at my history and decided to also check the adrenal glands, which sit on top of the kidneys so that was his call.

Turns out I had primary hyperaldosteronism which causes low potassium and high blood pressure. Not clear if it was the cause all along because I'm not sure I had my potassium checked before starting the diuretic. I saw a very good endocrinologist who had tests done to confirm the MRI and make sure that they removed the correct adrenal gland and then I eventually went down to a low dose of only one BP med.

Holy shit, me too.

Me three, although my procedure did not result in quite so dramatic an improvement. I saw a PCP for the first time in several years, and was 180/130. Four meds (vasodilator, calcium channel blocker, diuretic, and beta blocker) brought that down to 130-140/80-90. After removing an adrenal gland, I'm in that same range with three meds (same three minus the beta blocker, which never did much anyway).

Regarding this potassium paper, it's interesting that it primarily concerns itself with sodium and potassium intake. I don't know that any reasonable change to my intake could have overcome the effects of aldosterone overproduction, but wouldn't the recommended changes to your diet depend on measuring your current balance?

I’m on three meds still, but generally run ~ 120/80. My K levels are now 4.3 mmol/L. Much better than the low 3s I had before.

During the work up I had to drink 18g/day of the foulest liquid ever to get my K levels high enough for the adrenal vein sampling to be valid.

I have High Blood Pressure since childhood. Been taking medications from 16 years (now in my 40s).

I asked a doctor what is the cause of my high BP. He replied "either spend money on finding the cause and take medications OR just accept the fact and start taking medications from now"

I chose the latter :(

For context, I'm Pakistani so no concept of health insurance. All money would have to come from my brokea$$ family so no choice really lol

New mathematical model shows how the body regulates potassium (2023)

https://phys.org/news/2023-01-mathematical-body-potassium.ht... -- https://news.ycombinator.com/item?id=34589454

Here is a great resource for foods high in potassium. Most fruits, roots and leaves are great sources for potassium + nature's multivitamins. Sweet potato fries with low/no salt and orange juice to drink are an accessible & kid friendly option on the go, and cover 30-50% RDI. Diabetics need to watch for phosphorus & sugar; GI people for fodmaps; for the rest of us, why not?

https://whfoods.org/genpage.php?tname=nutrient&dbid=90

I've struggled to lower my blood pressure consistently, and I've been told by doctors and always thought that reducing sodium is the most important thing to lower blood pressure. I was unaware of the role potassium plays in tandem with sodium, and will be trying to raise the amount of potassium in my.

I also did not know that 1 banana a day is not enough potassium, you should eat more than that! I eat a banana almost everyday and always thought that covered my potassium. I am now trying to eat more leafy greens that are also a good source of potassium.

You can make your own electrolyte drinks.

Typically sport drinks have carbs, salt, potassium chloride, and magnesium. Mineral waters have salts, potassium and magnesium. You can buy potassium chloride, and magnesium citrate powder and leave sugars and salts out or reduce them. I haven't looked, but there might be already products that suit you.

Boom, magnesium is another important factor in balancing electrolytes for cardiovascular health. I would check out magnesium taurate instead of or in addition to the citrate. It seems to have a stronger association with managing blood pressure. Ideally one would get the minerals from a good diet, but I agree supplements are better than sports drinks.

This is a cool idea, thank you! I have not experimented with using magnesium specifically in any way, but have heard that it's a useful supplement to take.

Have you tried the grip strength or stress ball exercises (recommend adjustable grip strength machine)? Isometric exercises focused on the hands can reduce BP. Could be worth a look if you want to avoid drugs.

I've never heard of that, sounds pretty cool. It's surprising to me. I will check it out, thanks!

I have heard about isometric exercises helping reduce BP (there was a study posted on HN in the last 4 months or so), but I haven’t seen that they have to be hand exercises - are you sure of this?

There is debate about what is necessary. However, the vast majority of the studies in this area specifically looked at grip strength and grip strengthening exercises. Other isometric exercises (and exercise in general) have support for lowering blood pressure, but perhaps with less impact. Highest chance for success seems to be grip strength exercises. It's also something you can easily do while watching TV, which might improve adherence.

Is grip strength really a proxy for doing resistance training in general (people who do full workouts having stronger grip)? Just speculation on my part due to forearms not really being a major muscle group.

Some of the studies seem to control for this. Some have looked specifically at isometric vs eccentric, etc and found the isometric grip strength exercises to be more correlated.

On a side note, there have been studies about grip strength and lifespan, including on small children who have never strength trained at all. Higher grip strength had a fairly strong correlation with longer lifespan.

I don't know that it will lower your blood pressure by 10% -- The Washington Post article (below) -- but, there is evidence it helps some.

https://www.adityabirlacapital.com/healthinsurance/active-to...

https://www.washingtonpost.com/national/health-science/this-...

10% sounds high. 10mm Hg is what I've heard. Still significant.

Just FYI you can kill yourself pretty easily with potassium.

I'm not planning on taking any supplements, just trying to eat more foods with potassium in them to get up to 3,400 mg per day. I've probably been hitting like 1,000 mg per day if I had to guess.

You can kill easily only by injection in the blood, not by eating.

Eating even very large quantities will have little effects. They may cause diarrhea, but there is no chance of death.

I doubt this is true in all cases. I wouldn't recommend trying this and certainly would not trust my life to this advice.

I agree that if you take at once a quantity significantly greater than the recommended daily intake, for instance ten grams of potassium, there may exist some people with a combination of health problems, where instead of causing diarrhea such a dose would be absorbed in the blood instantaneously and some kidney disease will prevent the immediate elimination from the blood of that potassium, which would cause hyperkalemia.

On the other hand, if the dose does not exceed the recommended daily intake and it is taken after a meal, then it is pretty certain that it cannot have any bad effects in anyone who is not already dying.

There is absolutely no difference between the potassium contained naturally in food and the potassium added by a supplement. Therefore anyone who would be affected by the recommended daily intake would be equally affected by natural food or by a potassium supplement.

The main reason why potassium supplements are necessary is because potassium is lost very easily from food as a result of the methods used for preparation. Any kind of soaking or washing or boiling where the water is disposed is guaranteed to remove a part of the potassium (and of the magnesium), possibly most of it.

Potatoes with the skin on are probably the best vegetable source. Nutritious in other ways as well. And cheap too.

Unfortunately also one of the dirty dozen, and of course the pesticides and predominantly present on and in the skin.

The best potassium supplement is pure potassium citrate powder, which can be dissolved in drinking water.

Potassium chloride is cheaper, but it has the very undesirable effect of introducing in the body an excessive amount of chloride. Chloride is required in an amount very close to the amount of sodium and preferably somewhat less than sodium, while taking potassium chloride will ensure much more chloride than sodium (because the table salt already provides as much chloride as sodium), which will stress the kidneys, because they will need to restore the ionic balance.

It is preferable to also add in the water with potassium citrate a smaller quantity of a water-soluble magnesium supplement, e.g. pure magnesium bisglycinate powder (magnesium citrate is insoluble in water, so it is not useful).

This is great, I will check it out, thank you! I'm going to try and get the recommended daily amount of potassium from changing my diet initially. If I still struggle to get enough in my diet I'm going to try some supplements.

> reducing sodium is the most important thing

That's good to do, but by far the #1 thing for high blood pressure is exercise. A consistent schedule of intense cardio is probably the best single thing you can do for your health in general, and definitely for hypertension.

I was diagnosed with hypertension when I was 30. So I started cardio and diet change and all that.

No difference in my BP. So Fuck all that running nonsense. Granted, n=1.

Exercise is a fantastic idea, and the cardioprotective benefits are doubly important for those of us with hypertension, but it’s probably not going to lower your BP by more than a few points.

It's amazing I started running 3x a week and my blood pressure dropped 25 points (I also lost about 10 lbs)

Interesting recent blog suggesting that salt consumption and blood pressure are uncorrelated [0].

0. https://scottlocklin.wordpress.com/2024/08/23/crazy-but-like...

This comes up on reddit's /r/nutrition frequently. It's hard to get without supplements but there are a lot of ideas on there, some dried fruits like apricots have a surprisingly high amount for the calories.

One thing many people don’t think about is just giving blood regularly.

Easy, effective, and saves lives

The issue with sodium is not so much the total quantity but rather the osmolality. If you consume more sodium then you also need more water to prevent hypertension.

https://doi.org/10.1111/jch.13374

N=1 I tried taking potassium supplements and didn't see any noticeable effect on my blood pressure, unfortunately.

You probably didn’t take enough to meet even a fraction of your RDA, let alone enough to move the needle.

Potassium’s therapeutic window (the difference between effective dose and lethal dose) is relatively small. The FDA limits OTC potassium supplements to 99 mg per dose due to safety concerns like hyperkalemia. You'd need to take about 48 pills to meet the recommended daily amount of 4,700 mg, making it impractical compared to getting potassium from food.

The most widely available concentrated source of food grade potassium is potassium hydrogen tartrate, better known as cream of tartar, widely used in baking and cooking [1]. It's about 21% potassium by mass, available in practically any grocery store, and inexpensive in bulk. So it's a great alternative to potassium supplement pills, at least for people who can do arithmetic.

If people cannot do arithmetic, they may induce hyperkalemia:

Journal of Medical Toxicology, 2013: "Life-threatening hyperkalemia from cream of tartar ingestion"

https://sci-hub.se/10.1007/s13181-012-0255-x

Case reports: In both cases, individuals ingested a large quantity of cream of tartar in an effort to "clean themselves out". They manifested similar initial symptoms (vomiting), abnormal serum potassium (>8.0 mmol/L), and EKG's with peaked T waves. Both patients were treated for hyperkalemia and recovered without complication.

[1] https://en.wikipedia.org/wiki/Potassium_bitartrate

You are wrong. I am aware of the FDA limit on pills. That's why I used potassium chloride powder instead. I don't remember the exact amount, maybe half the RDA?

Morton makes a 50% sodium reduced salt. The other half is potassium chloride. Americans probably eat 3x as much sodium as they need. Adding potassium seems like a good thing according to this study so switching to that is probably good for anyone looking to control blood pressure.

IIRC the recommended Daily Value for sodium is strictly LESS than 2300 milligrams (mg) per day, while potassium should be over 4700, nearly 2:1. If anything, it sounds like there ought to be a >50% product.

I see cream of tartar is 1 cent per gram in bulk, ~5 cents per 1000mg potassium.

I get around 1600 mg of Salt from my medicine alone. ideal limit is 1500 mg while recommended limit is around 2300 mg (teaspoon of table salt) as you indicated.

Reply on news.ycombinator.com