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February 13, 2024 – New research suggests that replacing regular salt with a potassium-enriched salt substitute could significantly reduce the risk of developing hypertension, without causing hypotension. The findings, published in the Journal of the American College of Cardiology, highlight the potential of salt substitution as a population-wide strategy for preventing cardiovascular disease.
The DECIDE-Salt clinical trial, led by Dr. Yangfeng Wu from Peking University Clinical Research Institute in Beijing, China, involved 1612 participants aged 55 years or older residing in residential elderly care facilities. The trial assessed the impact of two sodium reduction strategies on blood pressure: replacing salt with a salt substitute and progressively restricting the salt supply.
Among the participants with normal blood pressure at the beginning of the study, those who substituted regular salt with a potassium-enriched salt substitute were 40% less likely to develop hypertension over two years compared to those who continued using regular salt. Notably, there was no increase in episodes of hypotension observed in the salt substitute group.
“This study indicates that everyone, regardless of blood pressure status, can benefit from replacing regular salt with potassium-enriched salt substitute,” stated Dr. Wu. “Salt substitution should be considered and promoted as a whole-population strategy for the prevention and control of hypertension and cardiovascular disease.”
The post hoc analysis of the DECIDE-Salt trial adds to the growing body of evidence supporting the efficacy of salt substitution in hypertension prevention. Previous research from Peru also demonstrated a significant reduction in the risk of developing hypertension among participants using salt substitutes.
Commenting on the study, Dr. Ankur Shah from Brown University emphasized the significance of the findings, particularly in the context of conflicting reports on the effects of salt substitution in individuals with normal blood pressure. While acknowledging the population-level implications of the study’s design, Dr. Shah highlighted potential concerns regarding salt substitutes in patients with kidney disease, who are typically advised to limit potassium intake.
The study’s design as a cluster-randomized trial at the facility level provides a clear path to implementation, particularly in elderly care facilities. However, caution is warranted when extrapolating the findings to the general population, as individual health considerations and potential risks associated with salt substitutes need to be carefully evaluated.
The research, supported by the National Key Research and Development Program of China, underscores the importance of exploring innovative strategies for sodium reduction and hypertension prevention. Further studies are needed to assess the long-term effects and broader implications of salt substitution on cardiovascular health.
As the global burden of hypertension continues to rise, initiatives promoting healthier dietary habits, such as salt substitution, offer promising avenues for combating this leading risk factor for cardiovascular disease.
