High blood pressure is a major contributor to premature death, and cardiovascular diseases remain the leading cause of death globally. Despite this, more than half of high blood pressure cases, which affect around 1.28 billion people worldwide, go undiagnosed.
Excessive consumption of sodium, or salt, is a primary factor that poses a threat to blood pressure.
A team of international researchers has discovered that incorporating dietary salt substitutes can potentially decrease the risk of heart attack, stroke, and mortality caused by cardiovascular disease.
In their analysis of available evidence, the researchers found that these beneficial effects can have a global impact on individuals, as reported in the journal BMC Heart. The researchers emphasized that a diet high in sodium and low in potassium often leads to an increase in blood pressure, a condition that affects approximately 1.28 billion people worldwide.
They also highlighted the effectiveness of salt substitutes, which replace a portion of sodium chloride (NaCl) with potassium chloride (KCl), in reducing blood pressure levels.
A recent study conducted in China called the Salt Substitute and Stroke Study (SSaSS), revealed that the use of salt substitutes can significantly reduce the risk of heart attacks, stroke, and premature death.
However, it was unclear if the benefits observed in SSaSS, which is currently the largest potassium-enriched salt substitute trial, are applicable worldwide or solely in China.
To address this, researchers conducted a review of clinical trials published until August 2021 that investigated the effects of salt substitutes on blood pressure, cardiovascular health, and mortality. They analyzed the results of 21 pertinent international clinical trials involving almost 30,000 participants conducted in various regions, including Europe, the Western Pacific, the Americas, and South-East Asia.
Throughout the study, which lasted between one month to five years, the proportion of sodium chloride in salt substitutes ranged from 33% to 75%, while potassium levels ranged from 25% to 65%. The results indicated that the use of salt substitutes effectively lowered blood pressure among all participants.
The analysis showed a reduction of 4.61mmHg in systolic blood pressure and 1.61mmHg in diastolic blood pressure, with consistent results observed regardless of various factors such as geography, age, sex, history of hypertension, weight, and baseline levels of urinary sodium and potassium.
Moreover, each 10% reduction in the proportion of sodium chloride in the salt substitute resulted in a 1.53mmHg reduction in systolic blood pressure and a 0.95mmHg reduction in diastolic blood pressure.
According to researchers from Australia, China, Sweden, Peru, the UK, and the US, there is no indication that consuming higher amounts of dietary potassium has any adverse health effects.
In a more comprehensive analysis of five trials, which included approximately 24,000 participants, the researchers discovered that salt substitutes reduced the likelihood of premature death from any cause by 11%, cardiovascular disease by 13%, and the risks of heart attack or stroke by 11%. The researchers, including some from the Imperial College of Science Technology and Medicine, emphasized that their findings were consistent with those of the SSaSS study.
The researchers stated that the consistent reduction in blood pressure provides compelling evidence for the cardiovascular protective effects of salt substitutes to be applicable globally, beyond the borders of China.
They further stated that their findings support the implementation of salt substitutes in both clinical and public health policies as a means to decrease dietary sodium intake, enhance dietary potassium intake, reduce blood pressure, and prevent significant cardiovascular events.
According to Tracy Parker, a heart health dietitian at the British Heart Foundation, this study is a useful reminder to reduce our salt intake and search for alternative options.
“However, while low salt substitutes have less sodium than regular salt, they still contain potassium which may not be suitable for some people with a heart problem and other existing health conditions.”
It’s better to “eat less salt,” according to the expert.
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