Study Finds Low Adoption of Salt Substitutes Among U.S. Adults with High Blood Pressure

A comprehensive analysis of nearly two decades of U.S. health survey data indicates that salt substitutes are rarely used by individuals with high blood pressure, despite being an inexpensive and effective strategy for sodium reduction and blood pressure management. The study, presented at the American Heart Association's Hypertension Scientific Sessions 2025, examined data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2020, representing the first long-term assessment of salt substitute usage patterns among a nationally representative sample of U.S. adults.

The research found that overall salt substitute use among all U.S. adults remained consistently low, peaking at just 5.4% in 2013-2014 before declining to 2.5% by 2017-March 2020. Among adults eligible to use salt substitutes—those with normal kidney function who weren't taking medications or supplements affecting blood potassium levels—usage rates ranged from only 2.3% to 5.1%. The analysis specifically focused on people with high blood pressure, a condition affecting 122.4 million (46.7%) U.S. adults according to 2017-2020 data, which contributes to more than 130,000 deaths annually.

Usage patterns varied among hypertension subgroups, with the highest rates observed in people whose blood pressure was controlled with medications (3.6%-10.5%), followed by those with treatment-resistant hypertension (3.7%-7.4%). Salt substitute use remained below 5.6% among individuals with untreated high blood pressure and those with normal blood pressure. The study also noted that adults who frequently ate at restaurants appeared less likely to use salt substitutes, though this difference lost statistical significance after adjusting for demographic factors.

Lead study author Yinying Wei emphasized the significance of these findings, stating that less than 6% of all U.S. adults use salt substitutes despite their affordability and effectiveness, particularly for individuals with difficult-to-treat hypertension. Health care professionals can play a crucial role in increasing awareness by discussing the safe use of salt substitutes with patients who have persistent or hard-to-manage high blood pressure. Salt substitutes typically replace sodium with potassium, which tastes similar to regular salt but may have a bitter aftertaste when heated.

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, especially those with hypertension. Reducing sodium intake by 1,000 mg per day can significantly improve blood pressure and heart health for most people. However, caution is advised as some salt substitutes contain potassium that can raise blood potassium to dangerous levels in people with kidney disease or those taking certain medications. Individuals considering switching to salt substitutes should first consult with health care professionals.

Dr. Amit Khera, an American Heart Association volunteer expert, described the findings as highlighting an important and easily missed opportunity to improve blood pressure management in the U.S. The persistently low usage rates over two decades underscore the need for increased patient and clinician awareness about these alternatives. The study's limitations include self-reported data that may involve underreporting, the inclusion of all salt substitute types without distinguishing potassium-enriched products specifically, and lack of information about usage quantities.

Future research should explore potential barriers to salt substitute adoption, including taste acceptance, cost factors, and awareness levels among both patients and clinicians. These insights could help develop more targeted interventions to increase utilization of this simple yet effective blood pressure management strategy. The complete study details and methodology are available through the American Heart Association's scientific conference materials at https://www.heart.org.