A recent study published in the *Journal of the American College of Cardiology* has revealed promising outcomes from using a salt substitute in preventing hypertension among normotensive older adults. The research titled “Effect of a Salt Substitute on Incidence of Hypertension and Hypotension Among Normotensive Adults” explored the impact of a salt substitute composed of 62.5% sodium chloride (NaCl), 25% potassium chloride (KCl), and 12.5% flavorings on the incidence of hypertension and hypotension.
The study was a post hoc analysis within the DECIDE-Salt trial, a large, multicenter, cluster-randomized trial conducted over two years in 48 elderly care facilities. It focused on older adults with normal blood pressure, using frailty survival models to compare the risk of developing hypertension and generalized linear mixed models to compare the risk of hypotension episodes between groups consuming the salt substitute and those consuming usual salt.
The findings were significant. The group consuming the salt substitute (n=313) showed a lower incidence of hypertension (11.7 vs. 24.3 per 100 person-years) with an adjusted hazard ratio (HR) of 0.60 (95% CI: 0.39 to 0.92; P=0.02) compared to the usual salt group (n=298). Interestingly, the incidence of hypotension episodes did not increase in the salt substitute group compared to the usual salt group (9.0 vs. 9.7 per 100 person-years; P=0.76). Additionally, the study noted that mean systolic/diastolic blood pressure did not rise from the baseline to the end of the intervention in the salt substitute group, resulting in a net reduction of −8.0 mm Hg in systolic and −2.0 mm Hg in diastolic blood pressure between the groups.
These results suggest that replacing usual salt with a salt substitute in the diet of older adults with normal blood pressure can significantly reduce the risk of developing hypertension without increasing the risk of hypotension episodes. The findings highlight the potential of salt substitutes as a viable strategy for the population-wide prevention and control of hypertension and cardiovascular disease. This study underscores the need for further research to explore the broader implications of salt substitution on public health, particularly among different populations and age groups.
The research conducted by Xianghui Zhang, Yifang Yuan, Chenglong Li, Xiangxian Feng, Hongxia Wang, Qianku Qiao, Ruijuan Zhang, Aoming Jin, Jiayu Li, Huijuan Li, and Yangfeng Wu offers critical insights into dietary interventions for hypertension prevention. Given the global burden of cardiovascular diseases, the study’s implications could pave the way for significant public health policies aimed at reducing salt intake through feasible and effective measures like salt substitution.
Journal Reference – Zhang, X., Yuan, Y., Li, C., Feng, X., Wang, H., Qiao, Q., … Wu, Y. (2024). Journal of the American College of Cardiology, 83(7), 711–722. doi:10.1016/j.jacc.2023.12.013
