TargetingtheDietaryNa:KRatio—Considerations forDesignofanInterventionStudytoImpact BloodPressure

Abstract

Despite medical, dietary, and lifestyle recommendations and drug advancements, hypertension persists as among the most prevalent noncommunicable diseases in the US population, and control remains elusive. Uncontrolled hypertension may increase the risk of serious illness fromvariousotherhealthchallenges,includingcardiovascularandrenalresponses.Adoptionofahealthydietisaconsistentcoreelementoflifestyle modifications that are recommended for mitigation of hypertension. The dietary sodium-to-potassium ratio is recognized as having promising potential in the regulation of blood pressure. In fact, the understanding of the relation between this ratio and blood pressure was documented as a key evidence gap in the 2019 National Academies of Sciences, Engineering, and Medicine report that revised recommended intake levels for both sodium and potassium. Although notable animal and human evidence supports this point, fundamental to developing a specific dietary recommendationforasodium-to-potassiumratioisawell-designedhumaninterventiontrial.Thesuccessfultranslatabilityofsuchatrialwillrequire careful consideration of study elements, including the study population, duration, blood pressure measurement, and dietary intervention, among other factors. This paper addresses these decision points and serves as supporting documentation for a research group or organization with the interestandmeanstoaddressthisimportantdatagap,whichwillundoubtedlybefoundationalforadvancingdietaryguidanceandwouldinform thenextiterationofDietaryReferenceIntakesforsodiumandpotassium