A recent study in the Journal of the American College of Cardiology found that replacing conventional salt with a salt substitute can lower the incidence of hypertension, or high blood pressure, in older persons without raising the risk of low blood pressure episodes. People who used a salt replacement had a 40% reduced incidence and risk of developing hypertension than those who used conventional salt.
According to the World Health Organization, hypertension is the leading risk factor for cardiovascular disease and mortality. It affects more over 1.4 billion adults and causes 10.8 million deaths worldwide each year. Reducing salt intake is one of the most effective approaches to minimize the risk of hypertension. This study investigates salt alternatives as a more effective way to regulate and maintain healthy blood pressure than lowering salt alone.
“Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods,” said Yangfeng Wu, MD, PhD, the study’s senior author and Executive Director of Peking University Clinical Research Institute in Beijing, China. “It’s crucial to recognize the impact of our dietary choices on heart health and increase the public’s awareness of lower-sodium options.”
Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals.
Yangfeng Wu
The researchers in this study looked at the effect of salt reduction measures on blood pressure in older persons living in care homes in China. While prior research has shown that lowering salt intake helps prevent or delay new-onset hypertension, long-term salt restriction and avoidance can be difficult.
The DECIDE-Salt trial comprised 611 adults aged 55 and higher from 48 care facilities, divided into two groups: 24 facilities (313 participants) using the salt substitute instead of regular salt, and 24 facilities (298 participants) using regular salt. At baseline, all patients had blood pressure <140/90mmHg and did not use antihypertensive drugs. The primary outcome was participants who developed incident hypertension, started antihypertensive medicines or experienced significant 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.
“Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals,” Wu said. “Considering its blood pressure — lowering effect, proven in previous studies, the salt substitute shows beneficial to all people, either hypertensive or normotensive, thus a desirable population strategy for prevention and control of hypertension and cardiovascular disease.”
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.
In an accompanying editorial comment, Rik Olde Engberink, MD, PhD, researcher, nephrologist, and clinical pharmacologist at Amsterdam University Medical Center’s Department of Internal Medicine, stated that the study provides an appealing alternative to the failed strategy of reducing salt intake worldwide, but questions and effort remain.
“In the DECIDE-Salt trial, the salt substitute was given to the kitchen staff, and the facilities were not allowed to provide externally sourced food more than once per week,” Olde Engberink, the study’s investigator, stated. “This approach potentially has a greater impact on blood pressure outcomes, and for this reason, salt substitutes should be adopted early in the food chain by the food industry so that the sodium-potassium ratio of processed foods will improve.”
