Salt substitute may reduce high blood-pressure problems

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Researchers from around the world have found that replacing regular salt with a sodium substitute can reduce high blood pressure among older adults without increasing their risk of low blood-pressure episodes. The team included participants aged 55 and older from 48 facilities. Participants were divided into two groups. One group consisted of 313 participants who replaced their usual salt with salt substitutes, while the other group (298 participants) continued to use regular salt. After two years, those who used the salt substitute were 40% more likely to develop hypertension than those who used regular salt. The salt substitutes didn’t cause hypotension either, according to the team, which is a problem that can affect older adults. In the same study, A second paper with the same authors(to be published by a different journal at a slightly different embargo date) found that salt substitution was more cost-effective. Together, these findings suggest that salt substitutes are not only healthy, but also cost effective.

Journal/conference: Journal of the American College of Cardiology

Organisation/s:Peking University Clinical Research Institute in China



Funder: This trial was funded by the National Key Research and Development
Through the Ministry of Science and Technology of China’s Program
the research grant “Diet, Exercise and Cardiovascular Health
(DECIDE) Project” (2016YFC1300200). China Salt General Company is located at
Yulin provided salt and salt substitutes used in the study for free
Charge. The authors have stated that they do not have any relationships.
Relevant to the contents of the paper to disclose.

Media Release

From: American College of Cardiology

Salt Substitutes Maintain Healthy Blood Pressure In Older Adults

DECIDE-Salt Study : salt substitutes are a healthy alternative for salt reduction. They lower hypertension risk and do not increase low blood pressure episodes.

WASHINGTON (Feb. 12, 2024) –According to a study published in the Journal of Hypertension, replacing regular salt with salt substitutes can reduce hypertension or high blood pressure in older adults, without increasing their risk for low blood pressure episodes. Journal of the American College of Cardiology. People who use a salt alternative have a 40% lower risk of hypertension and a 40% lower incidence compared to people who use regular salt.

According to the World Health OrganizationHypertension is a leading cause of cardiovascular disease and death. It affects more than 1.4 billion adult and causes 10,8 million deaths each year. Reducing sodium intake is a great way to reduce the risk of hypertension. This study examines the use of salt substitutes in order to maintain and control healthy blood pressure.

“Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods,”Yangfeng Wu MD, PhD is the lead author of this study and Executive Director at Peking University Clinical Research Institute. “It’s crucial to recognize the impact of our dietary choices on heart health and increase the public’s awareness of lower-sodium options.”

Researchers in this study evaluated the impact of sodium reduction strategies on blood pressure in elderly adults residing in care facilities in China. While previous studies prove that reducing salt intake can prevent or delay new-onset hypertension, long-term salt reduction and avoidance can be challenging.

The DECIDE-Salt study included 611 participants 55 years or older from 48 care facilities split into two groups: 24 facilities (313 participants) replacing usual salt with the salt substitute and 24 facilities (298 participants) continuing the use of usual salt. All participants had blood pressure <140/90mmHg and were not using anti-hypertension medications at baseline. The primary outcome was participants who had incident hypertension, initiated anti-hypertension medications or developed major cardiovascular adverse events during follow-up.

At two years, the incidence of hypertension was 11.7 per 100 people-years in participants with salt substitute and 24.3 per 100 people-years in participants with regular salt. People using the salt substitute were 40% less likely to develop hypertension compared to those using regular salt. Furthermore, the salt substitutes did not cause hypotension, which can be a common issue in older adults.

“Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals,”Wu said. “Considering its blood pressure-lowering effect, proven in previous studies, the salt substitute shows beneficial to all people, either hypertensive or normotensive, thus a desirable population strategy for prevention and control of hypertension and cardiovascular disease.”

The study has limitations, including that it was a post-hoc study analysis, the study outcomes were not specified in advance and many patients lost their follow-up appointments. The analyses showed that these missing values are random and multiple sensitivity analysis support the robustness.

In an accompanying editorial comment, Rik Olde Engberink, MD, PhD, researcher, nephrologist and clinical pharmacologist at Amsterdam University Medical Center’s Department of Internal Medicine, said the study provides an attractive alternative to the failing strategy to reduce the intake of salt worldwide, but questions and effort remain.

“In the DECIDE-Salt trial, the salt substitute was given to the kitchen staff, and the facilities were not allowed to provide externally sourced food more than once per week,” Olde Engberink said. “This approach potentially has a greater impact on blood pressure outcomes, and for this reason, salt substitutes should be adopted early in the food chain by the food industry so that the sodium-potassium ratio of processed foods will improve.”

The American College of CardiologyGlobal leader in improving heart care and transforming cardiovascular medicine, ACC has been a pioneer of this transformation since 1949. Since 1949, ACC has been the leading source of professional medical training for the entire cardiovascular team. It certifies cardiovascular professionals in more than 140 countries who meet strict qualifications. It also leads in the development of health policy, guidelines, and standards. The College’s world-renowned JACC Journals family, NCDR registries and ACC Accreditation Services as well as its global network of Member sections, CardioSmart patient resources, and more are all part of the College’s commitment to a world in which science, knowledge and innovations optimize patient care. Visit the website to learn more. www.ACC.orgFollow @ACCinTouch.

The ACC’s family of JACCJournalsThe journal is ranked among the top cardiovascular journals worldwide for scientific impact. The flagship journal, The Journal of the American College of Cardiology — and family of specialty journals consisting of JACC Advances, Asia, JACC Basic to Translational Sciences, CardioOncology JACC, Cardiovascular Imaging, JACC: Cardiovascular interventions, JACC Case Reports and JACC: Heart Failure — pride themselves on publishing the top peer-reviewed research on all aspects of cardiovascular disease. Learn more at JACC.org.


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