to the editor: Many of my patients with hypertension are interested in avoiding medication, so I appreciate the insights and practice pointers contained in this article.

Conspicuously absent from the discussion, however, is dietary potassium. Perhaps this is because Drs. Oza and Garcellano chose to rely primarily on recommendations from the 2013 American Heart Association/American College of Cardiology (AHA/ACC) guidelines on lifestyle management to reduce cardiovascular risk, which concluded there was insufficient evidence that increasing dietary potassium intake lowers blood pressure.¹

The same year those guidelines were published, a meta-analysis evaluating the role of potassium in modulating cardiovascular risk factors reached a different conclusion, finding good evidence that increased potassium intake lowers blood pressure.² The magnitude of the effect—3.5 mm Hg systolic and 2 mm Hg diastolic—is probably also clinically relevant.

The review by Drs. Oza and Garcellano mentioned the possible but far from conclusive benefits of dietary supplements such as garlic and cocoa. However, it is also worth emphasizing potassium's potential role in helping patients reduce their blood pressure. This advice is implicit in widely accepted antihypertensive dietary guidelines. For example, the Dietary Approaches to Stop Hypertension diet, which the AHA/ACC guidelines endorse, is formulated to be higher in potassium than the average American diet.³

Persons at risk of hyperkalemia, such as those who have chronic kidney disease or take medicines that inhibit the renin-angiotensin-aldosterone system, should use caution in increasing their dietary potassium intake. However, for other patients with hypertension, increasing dietary potassium may be another reason to eat plenty of fruits and vegetables.