Salt Substitute Reduces HTN Risk among Older Adults with Normal BP: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

Last week, we reported on findings from a study published in the Journal of the American College of Cardiology that examined the effects of a salt substitute on incidence of hypertension (HTN) and hypotension among older adults with normal blood pressure.

The study

Researchers conducted a post-hoc analysis of the DECIDE-Salt study, 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 DECIDE-Salt 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. According to results of the original DECIDE-Salt study, the salt substitute (62.5% NaCl, 25% KCl, and 12.5% flavorings) lowered systolic BP by 7.1 mm Hg compared with usual salt, meeting the primary outcome of the trial.

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).

The findings

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).

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.

Authors' comment

"In Chinese older adults with normal blood pressure, replacing usual salt with a salt substitute may reduce the incidence of hypertension without increasing hypotension episodes. This suggests a desirable strategy for population-wide prevention and control of hypertension and cardiovascular disease, deserving further consideration in future studies."

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