Salt Substitutes Linked to Lower Risk of CVD and Death

According to current WHO guidelines, adults should consume less than 2,000 mg of sodium per day (i.e. about 5 grams of traditional table salt), and at least 3,510 mg of potassium per day.Dietary salt substitutes not only lower blood pressure but also have a clear impact on hard clinical endpoints, lowering the risk of myocardial infarction (MI), stroke, and death from all causes and cardiovascular disease (CVD). 

In salt substitutes, a proportion of sodium chloride is replaced with potassium chloride. They are known to help lower blood pressure, but less is known about their impact on hard clinical endpoints

Some recommendations

Maoyi Tian, PhD, with Harbin Medical University, Harbin, China, and the George Institute for Global Health, Sydney, Australia, and colleagues pooled data from 21 relevant parallel-group, step-wedge, or cluster randomized controlled trials published through August 2021 with 31,949 participants. 

A meta-analysis of blood pressure data from 19 trials that included 29,528 participants showed that salt substitutes lowered systolic blood pressure (SBP) by 4.61 mm Hg (95% CI, −6.07 to −3.14) and diastolic blood pressure (DBP) by 1.61 mm Hg (95% CI, −2.42 to −0.79).

The proportion of sodium chloride in the salt substitutes varied from 33% to 75%; the proportion of potassium ranged from 25% to 65%.

Each 10% lower proportion of sodium chloride in the salt substitute was associated with a 1.53 mm Hg (95% CI, −3.02 to −0.03; P = .045) greater reduction in SBP and a 0.95 mm Hg (95% CI, −1.78 to −0.12; P = .025) greater reduction in DBP.

Pooled data on clinical outcomes from five trials that included 24,306 participants, mostly from the The Salt Substitute and Stroke Study (SSaSS), showed clear protective effects of salt substitutes on total mortality (risk ratio [RR], 0.89), CV mortality (RR, 0.87), and CV events (RR, 0.89).

Reductions in blood pressure appeared consistent, irrespective of country, age, sex, history of high blood pressure, weight, baseline blood pressure, and baseline levels of urinary sodium and potassium.

The  results of this research demonstrate the impact of using substitutes to give our meals a salty taste. Salt substitutes in general have not demonstrated  adverse effects on people who are taking it. Nonetheless, it is important to exclude the people that have an elevated risk of hyperpotassemia such as chronic kidney disease or the interaction with medication that elevates serum potassium. 


Maoyi Tian1,Bruce Neal, (Ausgust 10, 2022). Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. British Medical Journal : Heart. Retrieved form : 


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