Salt substitutes, while effective for reducing sodium intake and managing blood pressure, remain significantly underutilized by Americans with hypertension according to new research presented at the American Heart Association's Hypertension Scientific Sessions 2025. The study analyzed nearly two decades of data from the National Health and Nutrition Examination Survey (NHANES) and found that less than 6% of all U.S. adults use these alternatives, despite their potential to help control blood pressure effectively.
The research revealed that salt substitute usage peaked at just 5.4% in 2013-2014 before declining to 2.5% by 2017-March 2020. Among adults specifically eligible to use salt substitutes—those with normal kidney function not taking medications affecting potassium levels—usage ranged from only 2.3% to 5.1%. Even among individuals with treated hypertension, usage remained disappointingly low, ranging from 3.6% to 10.5% for those with controlled blood pressure and 3.7% to 7.4% for those with uncontrolled hypertension despite medication.
Lead study author Yinying Wei emphasized the significance of these findings, stating that health care professionals can raise awareness about the safe use of salt substitutes by having conversations with patients who have persistent or hard-to-manage high blood pressure. The American Heart Association recommends consuming no more than 2,300 mg of sodium daily, with an ideal limit below 1,500 mg for most adults, especially those with hypertension. Cutting back by 1,000 mg daily can significantly improve blood pressure and heart health according to their guidelines available at https://www.heart.org.
The study's implications are substantial given that high blood pressure affects 122.4 million American adults and contributes to more than 130,000 deaths annually. Excessive sodium and insufficient potassium intake are well-established risk factors for hypertension, which can lead to serious cardiovascular events including heart attack and stroke. Salt substitutes, which replace sodium with potassium, offer a simple and inexpensive strategy to address these dietary concerns.
However, researchers noted important safety considerations. Some salt substitutes contain potassium, which can raise blood potassium to dangerous levels in people with kidney disease or those taking certain medications or potassium supplements. Excessive potassium can lead to irregular heart rhythms, making professional consultation essential before switching from regular salt. The study also found that adults who ate at restaurants three or more times weekly appeared less likely to use salt substitutes, though this difference became statistically insignificant after accounting for demographic factors.
Dr. Amit Khera, an American Heart Association volunteer expert, described the findings as highlighting an important and easy missed opportunity to improve blood pressure in the U.S. The consistently low usage over two decades underscores the need for increased awareness and discussion between patients and healthcare providers, particularly during hypertension-focused medical visits. Future research should explore barriers to adoption, including taste acceptance, cost, and limited awareness among both patients and clinicians to guide more targeted interventions.
