Salt Substitute Lowers Risk of Hypertension among Older Adults with Normal Blood Pressure

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Replacing usual salt with a salt substitute reduced the incidence of hypertension (HTN) without increasing HTN episodes in older adults with normal blood pressure (BP), according to a new study published in the Journal of the American College of Cardiology.¹

The findings, from a post-hoc analysis of the DECIDE-Salt study, showed that older adults with normal BP levels in China were approximately 40% less likely to develop HTN when using a potassium-enriched salt substitute (62.5% NaCl, 25% KCl, and 12.5% flavorings) for 2 years.¹

The results suggest that replacing usual salt with a salt substitute is “a desirable strategy for population-wide prevention and control of hypertension and cardiovascular disease, deserving further consideration in future studies,” wrote researchers.¹

The DECIDE-Salt clinical trial was a cluster-randomized trial conducted in 48 residential elderly care facilities in China for 2 years. In total, 1612 adults (1230 men, 382 women) aged 55 years and older were included in the study, which examined the effect of 2 sodium reduction strategies in reducing BP – replacing salt with a salt substitute and progressive restriction of the salt supply.²

According to results of the original DECIDE-Salt study—published April 13, 2023, in Nature Medicine—the salt substitute lowered systolic BP by 7.1 mm Hg compared with usual salt, meeting the primary outcome of the trial.²

The post hoc analysis of the DECIDE-Salt study focused on 611 participants (mean age, 71 years) with normal BP at baseline (mean BP, 121.9/74.4 mm Hg).¹

“We used the frailty survival model to compare risk of incident hypertension and the generalized linear mixed model to compare risk of hypotension episodes,” stated investigators.¹

Researchers found that compared with individuals in the usual salt group (n=298), those in the salt substitute group (n=313) experienced a lower incidence of HTN (11.7 vs 24.3 per 100 person-years [PY]; adjusted HR 0.60, 95% CI 0.39-0.92; P = .02) without an increase in episodes of hypotension (9.0 vs 9.7 per 100 PY; adjusted relative risk 1.10, 95% CI 0.59-2.07; P = .76).¹

Results also showed that mean systolic/diastolic BP did not increase from baseline to the end of intervention in the salt substitute arm (mean changes, −0.3 ± 11.9/0.2 ± 7.1 mm Hg), but did increase in the usual salt arm (mean changes, 7.0 ± 14.3/2.1 ± 7.5 mm Hg), leading to a net BP reduction of 8.0/2.0 mm Hg between intervention groups.¹

References:

• Zhang X, Yuan Y, Li C, et al. Effect of a salt substitute on incidence of hypertension and hypotension among normotensive adults. J Am Coll Cardiol. 2024;83:711-722.
• Yuan Y, Jin A, Neal B, et al. Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: A cluster-randomized trial. Nat Med. 2023;29:973-981.