J Clin Hypertens (Greenwich). 2026 Apr;28(4):e70263. doi: 10.1111/jch.70263.
ABSTRACT
Dietary sodium and potassium intake are key determinants of blood pressure (BP) control in hypertensive patients. However, their associations with longitudinal home BP control in patients with apparent treatment-resistant hypertension (aTRH) remain unclear. In this prospective cohort study, baseline 24-hour urinary sodium and potassium excretion, objective biomarkers of dietary sodium and potassium intake, as well as urinary sodium-to-potassium (Na/K) ratio were evaluated as exposure variables. The primary outcome was longitudinal home BP control during follow-up. Mixed-effects models were used to assess these associations. A total of 172 patients were followed for a median of 39.3 months, contributing 7547 morning and 6640 evening home BP measurements. After multivariable adjustment, each 1-standard deviation (SD) increase in urinary sodium excretion (99.49 mmol) was associated with poorer home systolic BP (SBP) control (morning: odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.89; evening: OR 0.65, 95% CI 0.44-0.96). Each 1-SD increase in the urinary Na/K ratio (1.98 units) was associated with poorer morning (OR 0.68, 95% CI 0.48-0.97) and evening home SBP control (OR 0.69, 95% CI 0.51-0.94). A higher Na/K ratio was also associated with poorer overall evening home BP control (OR 0.73, 95% CI 0.54-0.98). Consistent associations were observed when BP was analyzed as a continuous outcome. Urinary potassium excretion alone was not significantly associated with home BP control. Dietary sodium restriction and maintenance of sodium-potassium balance may represent important strategies for improving home BP control in patients with aTRH. Trial Registration: Not applicable. This study was a prospective observational cohort study with no assignment of participants to any intervention; thereby clinical trial registration was not required.
PMID:42035361 | DOI:10.1111/jch.70263