Sodium, potassium, and blood pressure regulation in Latin American populations: a critical narrative review of multifactorial determinants.

Background: Salt-sensitive hypertension represents a critical yet inadequately understood public health challenge in Latin America, where sodium intake substantially exceeds international recommendations while potassium consumption remains deficient. The complex interplay between dietary electrolytes, genetic susceptibility, and socioecological determinants necessitates comprehensive analytical frameworks that transcend traditional biomedical models. Methods: This critical narrative review synthesizes evidence from approximately 154 peer-reviewed publications identified through structured searches in PubMed/MEDLINE, LILACS, SciELO, Scopus, Web of Science, Google Scholar, and SciSpace, covering the period 2015-2025. Sources were selected to represent the breadth of available evidence on sodium and potassium intake patterns, blood pressure regulation, genetic determinants of salt sensitivity, and socioecological contexts in Latin American adult populations. A multi-level analytical framework incorporating physiological mechanisms, epidemiological evidence, genetic determinants, and socioecological contexts was applied for narrative synthesis. Studies published before 2015, including landmark trials and foundational epidemiological work, are cited as background context. Results: Latin American populations demonstrate consistently elevated sodium excretion (8.4-8.9 g/day salt equivalent) and inadequate potassium intake (1.4-1.5 g/day), yielding unfavorable sodium-to-potassium ratios strongly associated with hypertension prevalence and cardiovascular risk. The landmark Peruvian salt substitution trial demonstrated that community-wide replacement with potassium-enriched alternatives reduced systolic blood pressure by 1.29 mmHg, diastolic by 0.76 mmHg, and incident hypertension by 51% over 30 months. Salt sensitivity exhibits marked heterogeneity, modulated by genetic variants affecting renal sodium handling, obesity, age, and structural determinants governing food access. The sodium-to-potassium ratio emerges as a more robust predictor than either mineral independently. Conclusions: Understanding hypertension in Latin America requires integrating biological mechanisms with cultural practices, socioeconomic inequalities, and food system transformations. Evidence-based interventions including salt substitution, comprehensive sodium reduction strategies, and potassium enhancement must address implementation barriers including cost, industry engagement, surveillance gaps, and equity dimensions. Future research priorities include standardized exposure assessment protocols, scaled intervention trials, food-source attribution analyses, and socioecological implementation science to translate evidence into sustainable, equitable population health improvements.