Salt substitutes underused to control high blood pressure

Researchers report that few people in the USA use salt substitutes to help control high blood pressure despite the fact they are a simple and effective method to lower salt intake.

The findings were presented on September 4, 2025 at the American Heart Association’s Hypertension Scientific Sessions 2025.

“Overall, less than 6% of all U.S. adults use salt substitutes, even though they are inexpensive and can be an effective strategy to help people control blood pressure, especially people with difficult-to-treat high blood pressure,” said lead study author Yinying Wei, M.C.N., and Ph.D. candidate in the departments of applied clinical research and hypertension section, cardiology division, at UT Southwestern Medical Center in Dallas. “Health care professionals can raise awareness about the safe use of salt substitutes by having conversations with their patients who have persistent or hard-to-manage high blood pressure.”

This study is the first to examine long-term trends in the use of salt substitution among a nationally representative sample of U.S. adults. The investigators extracted and analyzed data from the National [USA] Health and Nutrition Examination Survey (NHANES) from 2003 to 2020. They studied products that replace salt with potassium-enriched or other alternative salts.

The analysis included 37,080 adults, ages 18 and older (37.9% were aged 18–39, 36.9% were aged 40–59 years, and 25.2% were aged 60 and older). And 50.6% of participants were women, 10.7% of participants self-reported their race as non-Hispanic Black, and 89.3% self-reported they were from other racial and ethnic groups.

The investigators divided the subjects into four cohorts based on presence or absence of high blood pressure (≥130/80 mm Hg) and whether they were using blood pressure lowering medication: 1) high blood pressure that was treated and controlled; 2) high blood pressure that was treated and not controlled; 3) untreated high blood pressure; and 4) those with normal blood pressure.

They classified salt types as ordinary salt (iodized salt, sea salt, kosher salt), salt substitute (potassium-enriched or other salt substitute) and no salt use.

They found that salt substitution among all U.S. adults remained low throughout the study period, peaking at 5.4% in 2013–2014 before declining to 2.5% by 2017–March 2020. Data collection for 2020 stopped before March because of the COVID pandemic.

Salt substation was highest among subjects with high blood pressure controlled with medications (3.6%–10.5%), followed by subjects with high blood pressure that was uncontrolled despite medications (3.7%–7.4%).

Salt substitute use remained consistently less than 5.6% among subjects with untreated high blood pressure and with normal blood pressure.

In a comment on the study, AHA expert Amit Khera, M.D., professor of medicine, clinical chief of cardiology and director of preventive cardiology at UT Southwestern Medical Center in Dallas, said ,“This study highlights an important and easy missed opportunity to improve blood pressure in the U.S.—the use of salt substitutes. The fact that use of salt substitutes remains so low and has not