Salt Substitutes for Blood Pressure Control

The replacement of regular salt with a salt substitute can reduce incidence of hypertension, or high blood pressure, in older adults without increasing their risk of low blood pressure episodes, according to a recent study in the Journal of the American College of Cardiology. People who used a salt substitute had a 40% lower incidence and likelihood of experiencing hypertension compared to those who used regular salt.

According to the World Health Organization, hypertension is the leading risk factor for cardiovascular disease and mortality.

It affects over 1.4 billion adults and results in 10.8 million deaths per year worldwide.

One of the most effective ways to reduce hypertension risk is to reduce sodium intake.

This study looks at salt substitutes as a better solution to control and maintain healthy blood pressure than reducing salt alone.

Researchers in this study evaluated the impact of sodium reduction strategies on blood pressure in elderly adults residing in care facilities in China.

While previous studies prove that reducing salt intake can prevent or delay new-onset hypertension, long-term salt reduction and avoidance can be challenging.

The DECIDE-Salt study included 611 participants 55 years or older from 48 care facilities split into two groups: 24 facilities (313 participants) replacing usual salt with the salt substitute and 24 facilities (298 participants) continuing the use of usual salt.

All participants had blood pressure <140/90mmHg and were not using anti-hypertension medications at baseline.

The primary outcome was participants who had incident hypertension, initiated anti-hypertension medications or developed major cardiovascular adverse events during follow-up.

At two years, the incidence of hypertension was 11.7 per 100 people-years in participants with salt substitute and 24.3 per 100 people-years in participants with regular salt.

People using the salt substitute were 40% less likely to develop hypertension compared to those using regular salt.

Furthermore, the salt substitutes did not cause hypotension, which can be a common issue in older adults.

Limitations of the study include that it is a post-hoc analysis, study outcomes were not pre-specified and there was a loss of follow-up visits in many patients.

Analyses indicated that these missing values were at random, and multiple sensitivity analyses supports the robustness of the results.


Xianghui Zhang, Yifang Yuan, Chenglong Li, Xiangxian Feng, Hongxia Wang, Qianku Qiao, Ruijuan Zhang, Aoming Jin, Jiayu Li, Huijuan Li, Yangfeng Wu. Effect of a Salt Substitute on Incidence of Hypertension and Hypotension Among Normotensive Adults. Journal of the American College of Cardiology, 2024; 83 (7): 711 DOI: 10.1016/j.jacc.2023.12.013

American College of Cardiology. (2024, February 12). Salt substitutes help to maintain healthy blood pressure in older adults. ScienceDaily. Retrieved February 14, 2024 from

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