Switching from regular salt to a salt substitute can lower the frequency of hypertension or elevated blood pressure in older adults without heightening the risk of episodes of low blood pressure, as revealed by a recent investigation published in the Journal of the American College of Cardiology. The study found that individuals using a salt substitute experienced a 40% reduction in the incidence and probability of developing hypertension compared to those who continued using regular salt.
The World Health Organization identifies hypertension as a primary risk factor for cardiovascular diseases and death globally, affecting more than 1.4 billion adults and causing approximately 10.8 million fatalities annually. One of the most productive methods to mitigate the risk of hypertension is lowering sodium consumption. The research examines salt substitutes as an improved approach for controlling and preserving optimal blood pressure levels over merely decreasing salt intake.
Yangfeng Wu, MD, PhD, the study’s lead researcher and the Executive Director of the Peking University Clinical Research Institute in Beijing, China, emphasized the importance of understanding the health implications of our dietary choices, particularly the excessive consumption of salt through processed foods that are both affordable and readily available. Wu highlighted the need for increasing awareness about low-sodium dietary options for better heart health.
This study assessed the effects of sodium reduction strategies on blood pressure among elderly individuals in Chinese care facilities. Despite previous research confirming that salt intake reduction can prevent or postpone the onset of hypertension, maintaining a long-term low-salt diet poses significant challenges.
The DECIDE-Salt study involved 611 participants aged 55 and over from 48 care facilities, divided into two groups: one with 313 participants replacing their usual salt with a salt substitute and another with 298 participants continuing with their regular salt consumption. All participants had a baseline blood pressure of 140/90mmHg and were not on medication for hypertension. The primary focus was on participants who developed hypertension, began hypertension medication, or encountered significant cardiovascular events during the study.
After two years, the rate of hypertension was 11.7 per 100 person-years among those using the salt substitute, compared to 24.3 per 100 person-years among those using regular salt, indicating a 40% lesser likelihood of developing hypertension with the salt substitute. Additionally, the salt substitute did not lead to hypotension, a concern for older adults.
Wu expressed enthusiasm about the findings, suggesting they significantly advance blood pressure management. This approach protects individuals’ health and reduces cardiovascular risk while enjoying flavorful meals. Given its effectiveness in lowering blood pressure demonstrated in previous studies, the salt substitute benefits both hypertensive and normotensive individuals, making it a desirable strategy for preventing and controlling hypertension and cardiovascular disease.
However, the study has limitations, including its nature as a post-hoc analysis, the need for pre-specified study outcomes, and many participants were lost to follow-up. Despite these challenges, analyses suggested the missing data were random, and multiple sensitivity analyses supported the robustness of the findings.
In an editorial comment accompanying the study, Rik Olde Engberink, MD, PhD, is a researcher, nephrologist, and clinical pharmacologist at Amsterdam University Medical Center’s Department of Internal Medicine. He praised the study for offering an appealing alternative to the global challenge of reducing salt intake. However, he noted that further questions and efforts are necessary. He highlighted the study’s approach of providing salt substitutes to kitchen staff and restricting external food sources. He suggested that adopting salt substitutes early in the food production chain could significantly impact blood pressure outcomes by improving the sodium-potassium ratio in processed foods.
More information: Yangfeng Wu et al, Effect of a Salt Substitute on Incidence of Hypertension and Hypotension Among Normotensive Adults, Journal of the American College of Cardiology. DOI: 10.1016/j.jacc.2023.12.013
Journal information: Journal of the American College of Cardiology Provided by American College of Cardiology
