Salt substitute cuts hypertension risk among older adults with normal blood pressure
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Key takeaways:
- Older adults living in China were 40% less likely to develop hypertension when using a salt substitute for 2 years.
- Hypotension incidence did not differ between the salt substitute and regular salt groups.
Replacing usual salt with a potassium-enriched salt substitute in the kitchens of elder care facilities in China for 2 years reduced risk for incident hypertension by approximately 40% for adults with normal BP, data show.
A post hoc analysis of the DECIDE-Salt study published in the Journal of the American College of Cardiology also showed the use of a salt substitute for people without hypertension did not increase risk for hypotension episodes and was associated with lower systolic and diastolic BP.
Data were derived from Zhang X, et al. J Am Coll Cardiol. 2024;doi:10.1016/j.jacc.2023.12.013.
“Among adults with normal BP, replacing regular salt with a salt substitute that contains 25% potassium chloride would stop BP rising with aging instead of reducing BP and thus effectively prevent the users from developing hypertension while not causing additional hypotension episodes,” Yangfeng Wu, MD, PhD, professor of epidemiology and sciences in clinical research at Peking University and executive director of Peking University Clinical Research Institute, Beijing, told Healio. “Together with evidence from previous research on the health benefits of potassium-enriched salt substitutes for adults with hypertension and high CV risk, these data add support for the use of potassium-enriched salt substitutes as a whole-population strategy, targeting hypertensive and normotensive people, for the prevention and control of CVD.”
Switching salt type across facilities
Wu and colleagues analyzed data from 611 adults aged 55 years or older with BP of less than 140/90 mm Hg and not taking any antihypertensive medications participating in DECIDE-Salt, a multicenter, cluster-randomized trial conducted across 48 facilities for older adults in China. The mean age of participants was 71 years; 74.3% were men. Of the 48 facilities, researchers assigned 24 to an intervention replacing usual salt with a salt substitute (n = 313) and 24 to continue with usual salt (n = 298), with local staff responsible for implementing the intervention, for 2 years. The salt substitute used in the study contained 62.5% sodium chloride, 25% potassium chloride and 12.5% dried food ingredient flavorings (mushroom, lemon, seaweed, hawthorn, wild jujube) and traces of amino acids. Follow-up visits took place at 6, 12, 18 and 24 months after randomization. The researchers compared the risk for incident hypertension and risk for hypotension episode using salt vs. a salt substitute.
At 2 years, the incidence of hypertension was 11.7 per 100 person-years among participants in the salt substitute and 24.3 per 100 person-years among participants in the usual salt group. Compared with the usual salt group, participants with the salt substitute were 40% less likely to develop hypertension (adjusted HR = 0.6; 95% CI, 0.39-0.92; P = .02); however, the incidence of hypotension episodes did not differ between the two groups.
Participants in the salt substitute group did not experience an increase in mean systolic or diastolic BP, though systolic and diastolic BP increased for participants in the usual salt group by a mean of 7 mm Hg and 2.1 mm Hg, respectively, leading to a net BP reduction of 8/2 mm Hg for participants in the salt substitute group.
“Due to the nature of the post hoc analysis, our findings from this study require predefined studies to confirm, among younger adults in particular,” Wu told Healio.
Salt substitution ‘attractive alternative’
In a related editorial, Rik H.G. Olde Engberink, MD, PhD, a nephrologist with Amsterdam UMC and the University of Amsterdam, noted that the DECIDE-Salt study used a novel design by providing salt substitute to the kitchen staff of elder care facilities, as opposed to providing salt substitutes directly to participants, which typically only interferes with about 10% of salt intake that is usually added during cooking or eating.
“Considering the failing strategy to reduce the intake of salt worldwide, salt substitution is an attractive alternative,” Olde Engberink wrote. “In the DECIDE-Salt trial, which is the basis for this post hoc analysis, the salt substitute was given to the kitchen staff, and the facilities were not allowed to provide externally sourced food more than one time per week. Such an approach has the potential to have a greater impact on sodium and potassium intake, and thereby BP and long-term outcomes. For this reason, salt substitutes should be adopted early in the food chain, by the food industry, so the sodium-to-potassium ratio of processed foods, which are responsible for 70% of the salt intake, will improve.”
As Healio previously reported, a review published in January in Hypertension recommended most people with hypertension use potassium-enriched salt, with researchers calling for formal clinical guidance regarding salt substitute use. In March 2023, FDA proposed a rule that would allow the use of “safe and suitable salt substitutes” in standardized foods, providing manufacturers with greater flexibility for reducing sodium content.
Reference:
For more information:
Yangfeng Wu, MD, PhD, can be reached at wuyf@bjmu.edu.cn.
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