A recent study published in the Journal of the American College of Cardiology has found that using salt substitutes instead of regular salt can be a healthy alternative for reducing salt intake. This can decrease the risk of hypertension without increasing low blood pressure episodes, especially in the elderly population.
The study reports that people who use salt substitutes are 40% less likely to experience hypertension than those who use regular salt. Hypertension is the primary risk factor for cardiovascular disease and mortality, affecting over 1.4 billion adults and causing 10.8 million deaths worldwide every year.
Reducing sodium intake is one of the most effective ways to lower the risk of hypertension. The study suggests that using salt substitutes can be a better solution for controlling and maintaining healthy blood pressure levels than merely reducing salt intake alone.
Study on Salt Substitution
“Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods,” said Yangfeng Wu, MD, PhD, lead author of the study and Executive Director of Peking University Clinical Research Institute in Beijing, China. “It’s crucial to recognize the impact of our dietary choices on heart health and increase the public’s awareness of lower-sodium options.”
In this study, researchers in China examined the effects of reducing sodium intake on blood pressure in elderly adults living in care facilities. While previous studies have demonstrated that reducing salt consumption can help prevent or delay the onset of hypertension, maintaining long-term salt reduction and avoidance can be challenging.
The DECIDE-Salt Study included 611 participants aged 55 and over from 48 care facilities. The participants were divided into two groups: one group of 24 facilities (313 participants) replaced regular salt with a salt substitute, while the other group of 24 facilities (298 participants) continued to use regular salt. All participants had a blood pressure below 140/90mmHg and were not taking hypertension medication at the beginning of the study. The primary outcome was the number of participants who developed incident hypertension, started taking anti-hypertensive medication, or experienced major cardiovascular adverse events during the follow-up period.
After two years, the incidence of hypertension was 11.7 per 100 person-years among participants who used the salt substitute, compared to 24.3 per 100 person-years among those who continued to use regular salt. People using the salt substitute were 40% less likely to develop hypertension compared to those using regular salt. Additionally, the salt substitute did not cause hypotension, a common issue in older adults.
Benefits and Limitations of Salt Substitutes
“Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals,” Wu said. “Considering its blood pressure-lowering effect, proven in previous studies, the salt substitute shows beneficial to all people, either hypertensive or normotensive, thus a desirable population strategy for prevention and control of hypertension and cardiovascular disease.”
The study has some limitations. Firstly, it is a post-hoc analysis and study outcomes were not pre-specified. Secondly, there was a loss of follow-up visits in many patients. However, analyses showed that these missing values were random, and multiple sensitivity analyses support the strength of the results.
In an accompanying editorial comment, Rik Olde Engberink, MD, PhD, a researcher, nephrologist, and clinical pharmacologist at Amsterdam University Medical Center’s Department of Internal Medicine, stated that the study offers an attractive alternative to the failing strategy of reducing salt intake worldwide. However, he also highlighted some questions and efforts that still need to be addressed.
“In the DECIDE-Salt trial, the salt substitute was given to the kitchen staff, and the facilities were not allowed to provide externally sourced food more than once per week,” Olde Engberink said. “This approach potentially has a greater impact on blood pressure outcomes, and for this reason, salt substitutes should be adopted early in the food chain by the food industry so that the sodium-potassium ratio of processed foods will improve.”
This news is a creative derivative product from articles published in famous peer-reviewed journals and Govt reports:
References:
1. Zhang, X., Yuan, Y., Li, C., Feng, X., Wang, H., Qiao, Q., … & Wu, Y. (2024). Effect of a salt substitute on incidence of hypertension and hypotension among normotensive adults. Journal of the American College of Cardiology, 83(7), 711-722.
2. Jin, A., Liu, K., Labarthe, D. R., Feng, X., Zhang, R., Wang, H., … & Wu, Y. (2020). Impact of salt substitute and stepwise reduction of salt supply on blood pressure in residents in senior residential facilities: design and rationale of the DECIDE-Salt trial. American heart journal, 226, 198-205.
3. Yu, J., Thout, S. R., Li, Q., Tian, M., Marklund, M., Arnott, C., … & Wu, J. H. (2021). Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: a randomized, double-blind, controlled trial. The American Journal of Clinical Nutrition, 114(1), 185-193.
4. Murray, C. J., Aravkin, A. Y., Zheng, P., Abbafati, C., Abbas, K. M., Abbasi-Kangevari, M., … & Borzouei, S. (2020). Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The lancet, 396(10258), 1223-1249.
5. Zhang, M., Wu, J., Zhang, X., Hu, C. H., Zhao, Z. P., Li, C., … & Wang, L. M. (2021). Prevalence and control of hypertension in adults in China, 2018. Zhonghua Liu Xing Bing Xue Za Zhi= Zhonghua Liuxingbingxue Zazhi, 42(10), 1780-1789.
This article presents encouraging findings on the potential benefits of using salt substitutes to reduce the risk of hypertension.