Salt substitutes are widely recognized as a simple, inexpensive way to cut down on sodium and manage high blood pressure, yet new research shows that very few Americans with high blood pressure actually use them.
The findings were presented at the American Heart Association’s Hypertension Scientific Sessions 2025 in Baltimore.
High blood pressure, which happens when the force of blood against artery walls remains too high, affects nearly half of U.S. adults—about 122 million people between 2017 and 2020.
It contributes to more than 130,000 deaths every year.
Too much sodium and too little potassium in the diet are known risk factors, and salt substitutes, which replace some or all sodium with potassium, have been shown to lower blood pressure. Still, they remain largely overlooked.
“Less than 6% of all U.S. adults use salt substitutes,” said lead author Yinying Wei, a registered dietitian and Ph.D. candidate at UT Southwestern Medical Center in Dallas.
“They’re inexpensive, safe for many people, and effective—especially for those whose blood pressure is difficult to control. But awareness and use are very low.”
Salt substitutes are not new. They taste very similar to table salt, though some people notice a slightly bitter aftertaste when heated.
Since much of the sodium Americans consume comes from processed foods and restaurant meals, simply swapping table salt at home is not a complete solution, but it can still make a meaningful difference.
The American Heart Association recommends limiting sodium intake to 2,300 milligrams a day, with an ideal target of under 1,500 milligrams for adults with high blood pressure. Even reducing daily intake by 1,000 milligrams can improve heart health.
The study analyzed long-term national survey data from 2003 to 2020, looking at more than 37,000 adults.
Overall use of salt substitutes peaked at just 5.4% in 2013–2014 and then dropped to 2.5% by early 2020, just before the pandemic disrupted data collection. Among people with high blood pressure who were eligible to safely use salt substitutes—that is, those without kidney disease and not taking medications that affect potassium—use ranged between only 2% and 5%.
Interestingly, usage was slightly higher among people whose blood pressure was controlled with medication or whose blood pressure remained high despite medication.
Yet even in these groups, substitute use rarely exceeded 10%. People with untreated high blood pressure and those with normal blood pressure also reported very low use.
The researchers noted that eating habits may play a role. Adults who frequently ate out at restaurants were less likely to use salt substitutes at home, although this connection weakened when researchers adjusted for other factors such as age, race, education, and insurance coverage.
While salt substitutes can be helpful, they are not safe for everyone.
Because many contain potassium, they can be dangerous for people with kidney disease or for those taking certain medications or potassium supplements, as too much potassium can cause irregular heart rhythms. Doctors recommend that anyone with high blood pressure talk with a health care provider before switching.
“This is an easy, missed opportunity to improve blood pressure in the U.S.,” said Dr. Amit Khera, a cardiologist at UT Southwestern who was not involved in the study. “The fact that usage remains so low after two decades is striking. It’s a reminder for both patients and doctors to talk about these options.”
The study does have limits. Information about salt substitute use was self-reported, which can be inaccurate, and researchers could not separate potassium-based substitutes from other types. They also didn’t have details about how much salt substitute people were actually consuming.
Still, the findings highlight an important point: a simple change like using a salt substitute could help millions of people better manage their blood pressure.
Future research will need to explore why usage remains so low, including whether cost, taste, or lack of awareness are the biggest barriers. For now, experts say patients and health professionals should start the conversation—because even small changes in sodium intake can save lives.
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