Issue: October 2022
Fact checked byRichard Smith

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August 10, 2022
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Salt substitutes consistently beneficial for BP, survival, CV events

Issue: October 2022
Fact checked byRichard Smith
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Salt substitutes consistently improved BP and lowered risk for mortality, CV mortality and CV events, according to a meta-analysis published in Heart.

“These findings are unlikely to reflect the play of chance and support the adoption of salt substitutes in clinical practice and public health policy as a strategy to reduce dietary sodium intake, increase dietary potassium intake, lower blood pressure and prevent major cardiovascular events,” the researchers wrote.

Infographic showing how salt substitution affects blood pressure and cardiovascular events.
Data were derived from Yin X, et al. Heart. 2022;doi:10.1136/heartjnl-2022-321332.

The researchers undertook the meta-analysis to determine the generalizability of the findings of the Salt Substitute and Stroke Study (SSaSS). As Healio previously reported, in the main results of SSaSS, switching from regular salt to a salt substitute reduced risk for stroke, CV events and death in adults in rural China with a history of stroke or at high risk for it.

For the meta-analysis, the researchers included 21 trials with 31,949 participants. Of the trials, 19 assessed effects on BP and five assessed effects on clinical outcomes.

Salt substitutes reduced systolic BP by –4.61 mm Hg (95% CI, –6.07 to –3.14) and diastolic BP by –1.61 mm Hg (95% CI, –2.42 to –0.79), according to the researchers.

The reductions in BP were consistent by region, age, sex, hypertension history, BMI, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (P for homogeneity > .05), Xuejun Yin, PhD candidate in food policy at The George Institute for Global Health, University of New South Wales, Sydney, and colleagues wrote.

Each 10% lower proportion of sodium chloride in a salt substitute was associated with a –1.53 mm Hg greater reduction in systolic BP (95% CI, –3.02 to –0.03; P = .045) and a –0.95 mm Hg greater reduction in diastolic BP (95% CI, –1.78 to –0.12; P = .025), according to the researchers.

Salt substitution was associated with reduced risk for total mortality (RR = 0.89; 95% CI, 0.85-0.94), CV mortality (RR = 0.87; 95% CI, 0.81-0.94) and CV events (RR = 0.89; 95% CI, 0.85-0.94), the researchers wrote, noting that 88% to 99% of data for clinical outcomes came from SSaSS.

“Since blood pressure lowering is the mechanism by which salt substitutes confer their cardiovascular protection, the observed consistent blood pressure reductions make a strong case for the generalizability of the cardiovascular protective effect observed in SSaSS both outside of China and beyond the SSaSS population,” Yin and colleagues wrote.

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