Rethinking the impact of dietary sodium and potassium on blood pressure to advance public health.

Public health guidelines emphasize sodium reduction as the key nutrient-focused dietary strategy to reduce hypertension and cardiovascular disease risk. However, successful reduction in sodium intake remains a significant challenge because of the prevalent preference for salt taste as well as the complexity of multiple interacting factors such as different dietary habits, food production, and biological/cultural variability in consumers. Although the role of potassium in blood pressure (BP) management has been acknowledged, the evidence for potassium's effect on BP has not been as strong as that for sodium, but this is changing. New understanding of the critical role inadequate potassium intake plays in the etiology of hypertension indicates that the nutrient-based public health strategy should now include increased potassium intake as a partner with sodium reduction. Although it is evident that a comprehensive strategy combining education, consumer engagement, technological innovation, and culturally relevant interventions is essential to improving cardiovascular health, we propose that dietary impact will be greater if we embrace a paradigm shift from the singular focus on sodium reduction to include increasing potassium intake. This article reviews the basis for current intake recommendations for sodium and potassium, the strategies for sodium reduction and potassium enhancement, challenges for implementation, and future directions for research and policy to accelerate public health progress at a time of rapid changes in the food supply and consumer choices.