Study Reveals Low Adoption of Salt Substitutes Among Hypertensive Patients

Recent research presented at the American Heart Association's Hypertension Scientific Sessions 2025 has highlighted a concerning trend: the limited use of salt substitutes among individuals diagnosed with high blood pressure. Despite the known benefits of these substitutes in reducing sodium intake, their adoption remains strikingly low.

High blood pressure, or hypertension, affects approximately 122.4 million adults in the United States, equating to nearly 46.7% of the adult population. This condition poses significant health risks, including an increased likelihood of heart attacks and strokes. Excessive sodium consumption, coupled with insufficient potassium intake, has been identified as a contributing factor to hypertension.

Lead researcher Yinying Wei, a Ph.D. candidate and registered dietitian at UT Southwestern Medical Center, pointed out the alarming statistic that less than 6% of U.S. adults utilize salt substitutes. These substitutes, which replace some or all sodium with potassium, can be a cost-effective strategy for managing blood pressure.

The American Heart Association recommends a sodium intake of no more than 2,300 mg per day, ideally limiting it to 1,500 mg, particularly for individuals with high blood pressure. Research indicates that reducing sodium intake by 1,000 mg daily may significantly enhance heart health.

This study is notable as it marks the first comprehensive analysis of long-term trends regarding the use of salt substitutes among a nationally representative sample of U.S. adults, utilizing data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020. The findings revealed that overall usage of salt substitutes among adults peaked at 5.4% in 2013-2014 but plummeted to 2.5% by 2017.

Among adults eligible to use these substitutes, including those with normal kidney function and not on medications affecting potassium levels, only 2.3% to 5.1% reported using salt substitutes. The trend was slightly higher in individuals with controlled hypertension due to medication, where usage ranged from 3.6% to 10.5%. In contrast, those with untreated hypertension or normal blood pressure consistently reported usage rates below 5.6%.

Interestingly, adults who dined out three or more times per week were less likely to adopt salt substitutes compared to those who ate out less frequently. However, this correlation diminished when adjusted for demographic factors such as age, race, education, and insurance status.

Experts emphasize the importance of healthcare professionals discussing salt substitutes with their patients, particularly those struggling with hypertension. Amit Khera, a volunteer expert with the American Heart Association, underscored the missed opportunity to improve blood pressure management through the wider adoption of salt substitutes, noting that the persistently low usage rate over the past two decades is concerning.

Potential barriers to the increased use of salt substitutes include taste preferences, costs, and a lack of awareness among both patients and healthcare providers. Wei calls for further research to identify these obstacles, suggesting that insights gained could lead to targeted interventions to promote the use of salt substitutes among those at risk for hypertension.

The analysis included 37,080 adults aged 18 and older, with a diverse racial and ethnic representation. Participants were categorized based on their blood pressure status and whether they were receiving treatment. The study also evaluated the frequency of restaurant dining to assess its impact on salt substitute usage.

As the findings reveal a significant gap in the adoption of salt substitutes, healthcare providers are urged to engage in conversations with patients about their dietary choices, particularly regarding sodium intake management.