Salt substitutes are a simple and effective way to reduce salt intake and improve heart health, yet surprisingly few people with high blood pressure use them. This is an important finding from a new preliminary study presented at the American Heart Association’s Hypertension Science Session 2025, a major conference focused on the latest advances in hypertension research and their connections to heart, kidney, and metabolic diseases.
High blood pressure develops when the force of blood moving through the arteries remains elevated. Over time, this can damage blood vessels and greatly increase your risk of heart attack, stroke, and other serious conditions.
Between 2017 and 2020, approximately 122.4 million (46.7%) adults in the United States had high blood pressure and more than 130,000 died. Diet plays a big role. Too much sodium and too little potassium are the main causes of increased blood pressure.
Salt Alternatives: A Low-Cost but Underutilized Option
“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 manage blood pressure, especially those with difficult-to-treat hypertension,” said study lead author Yingying Wei, MCN, RDN, LD, PhD. candidate in the Division of Cardiology, Applied Clinical Research and Hypertension at UT Southwestern Medical Center in Dallas.
“Health care professionals can raise awareness about the safe use of salt substitutes by talking to patients who have persistent or difficult-to-control hypertension.”
Salt substitutes work by replacing some or all of the sodium in regular salt with potassium. Potassium salts have a similar flavor, but can become slightly bitter when heated.
Many foods naturally contain sodium, but most people get the majority of their sodium intake through processed, prepared foods, and restaurant meals. The American Heart Association recommends limiting sodium intake to less than 2,300 mg per day, with an ideal goal of less than 1,500 mg for most adults, especially those with high blood pressure. Reducing your intake by even 1,000 mg per day can lead to significant improvements in blood pressure and overall heart health.
20 years of data reveals persistent gaps
This study is the first to track long-term trends in salt substitute use across a nationally representative group of U.S. adults. Researchers analyzed National Health and Nutrition Examination Survey (NHANES) data collected between 2003 and 2020, focusing on products that replace traditional salt with potassium-rich salts and salt alternatives.
Who can safely use salt substitutes?
The study also looked at subgroups of adults who are considered safe candidates for salt replacement, with particular attention to people with high blood pressure. This includes individuals with normal kidney function and individuals who are not taking medications or supplements that affect potassium levels.
Some salt substitutes contain potassium, which can build up to dangerous levels in people who have kidney disease or take certain medications or supplements. High potassium levels can cause heart rhythm abnormalities. For this reason, people with high blood pressure should consult a medical professional before making the switch.
Key findings: Utilization remains surprisingly low
Analysis showed that salt substitute use remains consistently low across the U.S. population.
- Usage peaked at 5.4% in 2013-2014, but declined to 2.5% from 2017-March 2020. Data collection in 2020 ended early due to the pandemic.
- Among those who could safely use salt substitutes, only 2.3% to 5.1% reported using salt substitutes.
- The highest rate of use was among people whose hypertension was controlled with medication (3.6% to 10.5%), followed by those whose blood pressure was not controlled despite treatment (3.7% to 7.4%).
- Less than 5.6% of people with untreated hypertension or normotension used salt substitutes.
- People who ate at restaurants three or more times a week appeared to be less likely to use salt substitutes, but this difference was not statistically significant after adjusting for demographic factors.
“For the past 20 years, the use of salt substitutes has not been common, including among people with high blood pressure,” Wei said. “Even among people with treated but poorly controlled or untreated hypertension, most continued to use regular salt.”
Experts call this a missed opportunity.
“This study highlights the use of salt substitutes as an important and often missed opportunity to improve blood pressure in the United States,” said Amit Khera, MD, FAHA, a volunteer specialist with the American Heart Association.
“The fact that the use of salt substitutes remains so low and has not improved for 20 years is striking and reminds patients and health professionals to discuss the use of salt substitutes, especially during visits focused on high blood pressure.”
Kela, who was not involved in the research, is a professor of medicine, clinical chief of cardiology, and director of preventive cardiology at UT Southwestern Medical Center in Dallas.
Research limitations and future challenges
The researchers note several limitations. Use of salt substitutes was self-reported, which may have led to underreporting or misclassification. The study also grouped all types of salt substitutes together, so it was not possible to distinguish between potassium-based products and other substitutes. Additionally, the data did not track how much salt substitutes participants used.
“Future research should explore why the use of salt substitutes remains low by investigating potential barriers such as taste acceptability, cost, and limited awareness among both patients and clinicians,” Wei said. “These insights may help guide more targeted interventions.”
Study design and participant details
The analysis included 37,080 adults aged 18 and older (37.9% aged 18-39, 36.9% aged 40-59, and 25.2% aged 60 and older). 50.6% of participants were female, 10.7% identified as non-Hispanic black, and 89.3% reported other racial and ethnic backgrounds.
Participants were grouped based on whether they had hypertension (≥130/80 mm Hg) and whether they were using medications (controlled hypertension, uncontrolled hypertension, untreated hypertension, or normal blood pressure).
Salt use was categorized as regular salt (iodised salt, sea salt, kosher salt), salt substitute (potassium fortified or other salt substitute), or no salt use.
Subgroup analyzes focused on people eligible for salt substitutes. These people are defined as those who have healthy kidney function (estimated glomerular filtration rate ≥ 60) and are not using drugs or supplements that affect potassium levels. Researchers also looked at how often participants ate at restaurants. All results took into account the NHANES sampling method and study design.
Research highlights
- Salt substitutes are rarely used, even though they reduce sodium intake and help control blood pressure.
- Increasing awareness may help improve outcomes for patients with hypertension, especially those with difficult-to-treat conditions.
- This study was funded by the National Institutes of Health.
Note: The research presented in this article is a research summary. Abstracts presented at American Heart Association scientific meetings are not peer-reviewed, and research results are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
