Study Finds Low Adoption of Salt Substitutes Among U.S. Adults with Hypertension

Salt substitutes remain significantly underutilized among Americans with high blood pressure, according to research presented at the American Heart Association's Hypertension Scientific Sessions 2025. The study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003 to 2020, representing the first comprehensive examination of long-term salt substitute usage trends in a nationally representative sample of U.S. adults.

The findings indicate that overall salt substitute use among all U.S. adults peaked at just 5.4% in 2013-2014 before declining to 2.5% by 2017-March 2020. Among adults specifically eligible to use salt substitutes—those with normal kidney function who were not taking medications or supplements affecting blood potassium levels—usage rates ranged from only 2.3% to 5.1%. The research highlights a critical gap in hypertension management strategies, particularly concerning given that high blood pressure affects 122.4 million (46.7%) U.S. adults and contributes to more than 130,000 deaths annually.

Lead study author Yinying Wei, M.C.N., R.D.N., L.D., and Ph.D. candidate at UT Southwestern Medical Center, emphasized the significance of these findings. "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 control blood pressure, especially people with difficult-to-treat high blood pressure," Wei stated. 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, particularly those with hypertension.

The study revealed important patterns among different hypertension subgroups. Usage was highest among individuals 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 consistently below 5.6% among people with untreated high blood pressure and those with normal blood pressure. The research also examined restaurant dining habits, finding that adults who ate at restaurants three or more times weekly appeared less likely to use salt substitutes, though this difference lost statistical significance after adjusting for demographic factors.

Salt substitutes typically replace sodium with potassium, offering similar taste characteristics to regular salt except for a potential bitter aftertaste when heated. While these products represent a simple intervention, they require careful consideration for individuals with kidney disease or those taking certain medications, as excessive potassium can lead to dangerous irregular heart rhythms. The American Heart Association provides comprehensive guidance on sodium reduction strategies through resources available at https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/shaking-the-salt-habit-to-lower-high-blood-pressure.

Dr. Amit Khera, M.D., M.Sc., FAHA, an American Heart Association volunteer expert not involved in the study, described the findings as "eye-opening." He noted, "The fact that use of salt substitutes remains so low and has not improved in two decades reminds patients and health care professionals to discuss the use of these substitutes, particularly in visits focused on high blood pressure." The research team recommends future investigations explore barriers to adoption, including taste acceptance, cost factors, and awareness levels among both patients and clinicians.

The study limitations include self-reported salt substitute usage data, potential underreporting or misclassification, and the inability to distinguish between potassium-enriched salt and other salt substitute types. Additionally, the survey data did not capture quantitative usage amounts. The research was supported by a grant from the National Institutes of Health and involved 37,080 adults aged 18 and older, with balanced representation across age groups and genders.