Very few people use this simple means to tame blood pressure, the study reveals

A new major study shows that less than 6% of American adults use salt substitutes, even if they can help reduce blood pressure and heart risk.

The preliminary results presented to the American Hypertension 2025 hypertension of the American Heart Association show that only a small share of people with high blood pressure use salt substitutes, even if these products offer a simple and effective means of reducing sodium intake and helping to manage blood pressure.

High blood pressure develops when the blood force growing against the walls of the artery remains constantly high. Over time, this condition considerably increases the risk of fatal complications such as heart attacks and cerebral vascular accidents. The data collected between 2017 and 2020 show that 122.4 million adults in the United States (46.7%) lived with high blood pressure, which was associated with more than 130,000 deaths during this period. Excess sodium and inadequate potassium contribution are among the main food contributors to this widespread health problem.

“Overall, less than 6% of all American adults use salt substitutes, even if they are inexpensive and can be an effective strategy to help people control blood pressure, in particular people with high blood pressure difficult to treat,” said the author of the main Yinying Wei, MCN, RDN, LD and PH.D. applied hypertension, cardiology division, at UT Southwestern Medical Center in Dallas. “Health professionals can raise awareness of the safe use of salt substitutes by having conversations with their patients who have high blood pressure persistent or difficult to manage.”

Salt substitutes: an underused solution

Salt substitutes are products in which a part or all sodium is replaced by potassium. Potassium salt has an ordinary table salt taste, although heating can produce bitter aftertaste. Sodium occurs naturally in many foods, but most contributions come from processed and packaged items and meals prepared in restaurants. THE

The American Heart Association advises to limit sodium to no more than 2,300 mg per day, with an ideal lens of less than 1,500 mg for most adults, especially those with high blood pressure. For most people, reduced daily sodium of around 1,000 mg can improve blood pressure and support heart health.

This study is the first to examine long -term trends in the use of salt substitute from a national sample on the national scale of American adults. Using data from the National Health and Nutrition Examination Survey (Nhanes) from 2003 to 2020, researchers have analyzed the use of products that replace salt with alternative potassium salts.

The survey focused on people with high blood pressure, and an additional analysis was carried out in eligible adults to use salt substitutes, including people with normal kidney function and those who do not take medication or supplements that affect blood potassium. Some salt substitutes contain potassium and can raise blood potassium at dangerous levels in people with kidney disease or those who take certain drugs or potassium supplements. Excessive potassium can cause irregular cardiac rhythms. People with high blood pressure who plan to go from ordinary salt to salt substitute should first consult a healthcare professional.

Study of results on the use of salt substitute

The analysis revealed:

• Overall, the use of salt substitute in all American adults remained low, culminating at 5.4% in 2013-2014 before falling to 2.5% by 2017 – March 2020. Data collection for 2020 stopped before March due to the pandemic.
• Among adults eligible to use salt substitutes, only 2.3% to 5.1% did.
• The use was highest in people with high blood pressure, the PA of which was checked with medicines (3.6% to 10.5%), followed by those with high blood pressure, the PA of which was not controlled despite medication (3.7% to 7.4%).
• The use of salt substitute remained systematically less than 5.6% in people with untreated high blood pressure and for people with normal blood pressure.
• Adults who ate in restaurants three times or more per week seemed less likely to use salt substitutes compared to those who ate less often, but this difference was no longer statistically significant after having counted age, race / ethnicity, level of education and insurance status.

“The use of salt substitute has remained rare in the past two decades, including among people with high blood pressure,” said Wei. “Even in people with hypertension treated and poorly managed or not treated, most of them continued to use ordinary salt.”

“This study highlights an important and easy missed opportunity to improve blood pressure in the United States – the use of salt substitutes,” said Amit Khera, MD, M.SC., Faha, a volunteer of the American Heart Association. “The fact that the use of salt substitutes is so low and has not improved in two decades is indicative and reminds patients and health professionals to discuss the use of these substitutes, especially in visits focused on blood pressure.” Khera, who was not involved in this study, is a professor of medicine, Cardiology Clinical Chef and Director of preventive cardiology at the UT Southwestern Medical Center in Dallas.

The study has several limits. First, information on the use of salt substitute was self-deprecated, so there may have been any sub-declaration or poor classification. In addition, all types of salt substitutes have been included in the analysis, therefore, the analysis could not specifically separate potassium salt from other types of salt substitutes. Finally, the survey data did not enter the amount of salt substituted by the participants used.

“Future research should explore why salt substitute consumption remains weak by studying potential obstacles, such as acceptance of taste, cost and limited awareness in patients and clinicians,” said Wei. “This information can help guide more targeted interventions.”

Study details, background and design

• The analysis included 37,080 adults, aged 18 and over (37.9% were aged 18 to 39, 36.9% were aged 40 to 59 and 25.2% were aged 60 and over). 50.6% of the participants were women, 10.7% of participants self -commissioned their race as a non -Hispanic black and 89.3% declared themselves coming from other racial and ethnic groups.
• Participants were classified into four sub-groups according to the presence or absence of high blood pressure (≥130 / 80 mm HG) and if they used drugs to lower blood pressure: 1) high blood pressure which was processed and controlled; 2) high blood pressure which has been treated and uncontrolled; 3) untreated high blood pressure; and 4) those with normal blood pressure.
• The types of salt have been classified as ordinary salt (iodized salt, sea salt, kosher salt), salt substitute (enriched with potassium or other salt substitute) and no use of salt.
• An additional analysis was carried out on a subgroup of eligible individuals to use salt substitutes – those by a healthy renal function (estimated glomerular filtration rate ≥ 60) and not take medications or supplements that affect blood potassium levels.
• The frequency of eating in restaurants to assess its influence on the use of salt substitute has also been evaluated.
• All analyzes incorporated Nhanes sampling weights and a complex survey design.

Meeting: scientific sessions of the American Heart Association 2025

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