Despite being a simple, affordable way to lower sodium intake, salt substitutes remain underused among Americans with high blood pressure, according to preliminary findings presented at the American Heart Association’s Hypertension Scientific Sessions 2025. The annual conference, held September 4–7 in Baltimore, is a leading forum for research on hypertension and related health risks, including heart disease, stroke, and kidney disease.
High blood pressure affects nearly half of U.S. adults—about 122.4 million people between 2017 and 2020—and contributed to more than 130,000 deaths in that period. Excess sodium and insufficient potassium intake are major dietary drivers of hypertension.
Researchers reported that fewer than 6% of adults use salt substitutes, even though these products can be an effective option for managing blood pressure, particularly in patients whose hypertension is difficult to control.
“Salt substitute use remained uncommon over the last two decades, including among people with high blood pressure,” said lead author Yinying Wei, M.C.N., R.D.N., L.D., a Ph.D. candidate at UT Southwestern Medical Center in Dallas. “Even among individuals with treated and poorly managed or untreated high blood pressure, most continued to use regular salt.”
What Are Salt Substitutes?
Salt substitutes typically replace some or all sodium with potassium. While potassium salt has a taste similar to regular salt, it may leave a bitter aftertaste when heated. Because most sodium intake comes from processed foods and restaurant meals—not table salt—the American Heart Association recommends adults limit sodium consumption to no more than 2,300 milligrams daily, ideally below 1,500 milligrams. Reducing sodium by even 1,000 milligrams a day can significantly improve blood pressure and heart health.
Study Details
This investigation is the first to assess long-term trends in salt substitute use using national survey data from 2003 to 2020. The analysis included U.S. adults with high blood pressure and a subgroup eligible to use substitutes safely—those without kidney disease and not taking medications or supplements that affect potassium levels.
Excess potassium can be dangerous for some patients, potentially causing irregular heart rhythms. Researchers emphasized that individuals with hypertension should consult health professionals before switching to potassium-based substitutes.
Key findings include:
Overall usage was low: Salt substitute use among U.S. adults peaked at 5.4% in 2013–2014, then dropped to 2.5% by early 2020.
Eligible adults: Only 2.3% to 5.1% reported use.
Among patients with high blood pressure: Use ranged from 3.6% to 10.5% among those with controlled hypertension, and 3.7% to 7.4% among those whose blood pressure remained uncontrolled despite medication.
Other groups: Usage stayed below 5.6% among people with untreated hypertension and those with normal blood pressure.
Lifestyle factors: Adults who ate at restaurants three or more times per week appeared less likely to use substitutes, though the difference was not statistically significant after adjusting for demographics and insurance status.
Dr. Amit Khera, a cardiologist at UT Southwestern Medical Center who was not involved in the study, called the findings a missed opportunity.
“The fact that use of salt substitutes remains so low and has not improved in two decades is eye-opening,” Khera said. “This underscores the need for clinicians and patients to discuss alternatives during hypertension management.”
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