Can a salt substitute reduce the risk of a stroke and heart events in patients with high blood pressure?

This study investigated if a salt substitute could reduce the risk of stroke and cardiovascular (CV) events in patients with hypertension (high blood pressure). The data showed that the salt substitute reduced the risks of stroke, major CV events, and death from any cause compared to regular salt in patients with hypertension.

Hypertension or high blood pressure (BP) is a common condition. It increases the risk of cardiovascular disease (CVD). It also increases the risk of major CV events such as heart attack or stroke. Dietary adjustment is one way to reduce BP. Usually, reducing salt intake is the first recommendation to lower BP. More than 50% of patients with high BP have excessive salt intake.

Replacing salt with salt substitutes may help to reduce blood pressure. Salt substitutes replace some of the sodium with potassium. Salt substitutes with reduced sodium levels and increased potassium levels have been shown to lower blood pressure, but their effects on CV events and safety outcomes are still unknown.

This study involved 20,995 patients with hypertension. Patients were randomly assigned into 2 groups. Group 1 included 10,504 patients who used a salt substitute (75% sodium chloride, 25% potassium chloride). Group 2 included 10,491 patients who used regular salt (100% sodium chloride). The average follow-up period was 4.74 years.

The salt substitute reduced the risk of stroke by 14% compared to regular salt. The salt substitute was also associated with significantly lower rates of major CV events (by 13%) compared to regular salt. The salt substitute also reduced the risk of death by any cause by 12% compared to regular salt.

The rate of serious side effects due to high potassium levels in the blood was similar between the two groups. 

This study concluded that the added potassium salt substitute reduced the risks of stroke, major CV events, and death from any cause compared to regular salt in patients with hypertension.

This study only included patients from China. More studies are needed to see if these findings apply to other countries as well.