Study Finds Low Usage of Salt Substitutes Among Americans With High Blood Pressure Despite Proven Benefits

Despite their proven effectiveness in reducing sodium intake and managing blood pressure, salt substitutes remain rarely used by individuals with high blood pressure, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The study, which analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020, found that overall usage among U.S. adults peaked at just 5.4% in 2013–2014 before declining to 2.5% by 2017–March 2020. Among those eligible to use salt substitutes—people with normal kidney function not taking medications affecting potassium levels—only 2.3% to 5.1% did so.

High blood pressure affects 122.4 million adults in the U.S. and contributes to over 130,000 deaths annually, with excessive sodium and insufficient potassium intake being key risk factors. Salt substitutes, which replace sodium with potassium, offer a simple and inexpensive strategy to address this, yet awareness and adoption remain low. Lead author Yinying Wei, a Ph.D. candidate at UT Southwestern Medical Center, emphasized that health care professionals can play a critical role by discussing salt substitutes with patients, particularly those with difficult-to-treat or treatment-resistant hypertension. The American Heart Association recommends consuming no more than 2,300 mg of sodium daily, with an ideal limit below 1,500 mg for most adults, and cutting intake by 1,000 mg per day can significantly improve heart health.

The analysis revealed that usage was highest among individuals with high blood pressure controlled by medications (3.6%–10.5%), followed by those with uncontrolled hypertension despite medication (3.7%–7.4%). However, salt substitute use remained below 5.6% for people with untreated high blood pressure and those with normal blood pressure. Interestingly, adults who ate at restaurants three or more times weekly appeared less likely to use salt substitutes, though this difference was not statistically significant after adjusting for factors like age and education. Wei noted that even among those with poorly managed hypertension, most continued using regular salt, underscoring a persistent gap in preventive care.

Amit Khera, an American Heart Association volunteer expert, described the findings as an eye-opening reminder of a missed opportunity to improve blood pressure management nationally. The study’s limitations include self-reported data, which may underreport usage, and the inability to distinguish potassium-enriched substitutes from other types. Future research should explore barriers such as taste acceptance, cost, and awareness among patients and clinicians to guide targeted interventions. For more information on sodium reduction, visit https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/shing-the-salt-habit-to-lower-high-blood-pressure.