High blood pressure, often called the “silent killer,” happens when the force of blood flowing through your arteries stays too high for too long.
It raises the risk of serious problems like heart attacks and strokes. In the United States alone, between 2017 and 2020, about 122 million adults—nearly half the adult population—had high blood pressure.
This condition contributed to more than 130,000 deaths, yet many easy steps to lower blood pressure are still overlooked.
One of the simplest ways to cut blood pressure is to reduce salt, or sodium, in the diet. Most people get far too much sodium, often from processed or restaurant foods. At the same time, many people eat too little potassium, a mineral that helps counterbalance sodium’s effects on blood pressure.
Salt substitutes replace some or all of the sodium in regular salt with potassium. They taste almost the same as normal salt, though some may leave a slightly bitter aftertaste when heated.
These substitutes are widely available and affordable, making them an attractive option for people trying to control their blood pressure.
Yet new research shows that very few people in the U.S. actually use salt substitutes, even those who have high blood pressure and could benefit the most. Preliminary findings presented at the American Heart Association’s Hypertension Scientific Sessions 2025 in Baltimore show that fewer than 6% of all U.S. adults use salt substitutes.
Use peaked at just 5.4% in 2013–2014 and fell to 2.5% by 2020. Among adults with high blood pressure, usage was still extremely low. Even those whose blood pressure was difficult to control with medications rarely turned to salt substitutes, with usage rates between 3.7% and 7.4%.
Among people eligible to use them safely—those with healthy kidneys and not on medications affecting potassium—usage stayed between 2.3% and 5.1%.
Salt substitutes aren’t for everyone. Because they contain potassium, they can raise blood potassium to unsafe levels in people with kidney disease or those taking certain drugs or supplements. Too much potassium can cause dangerous heart rhythm problems.
That’s why anyone thinking of switching to a salt substitute should check with a health care professional first. But for the majority of adults with normal kidney function, salt substitutes are a safe and effective tool to lower blood pressure.
Experts say these findings show a major missed opportunity. Lead author Yinying Wei of UT Southwestern Medical Center emphasized that health care professionals can play a key role by discussing salt substitutes with patients who have persistent or hard-to-control high blood pressure.
Amit Khera, a cardiologist and volunteer expert with the American Heart Association, who was not involved in the study, called the low use of salt substitutes “eye-opening” and urged clinicians and patients alike to consider them as part of blood pressure management.
The research, based on data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020, is the first to examine long-term trends in salt substitute use in a nationally representative sample.
It analyzed responses from over 37,000 adults and categorized participants by whether they had high blood pressure, were on medication, or had normal blood pressure.
Researchers also looked at how often people ate at restaurants. Adults who ate out three or more times a week were slightly less likely to use salt substitutes, although this difference disappeared after adjusting for age, race, education and insurance.
While the study had limitations, including reliance on self-reported data and an inability to separate potassium-enriched salts from other substitutes, its message is clear. Salt substitute use remains very low and hasn’t improved in two decades, even among people with high blood pressure.
This highlights a gap in public health education and awareness. Future research should look at why people are not using salt substitutes, whether due to taste, cost, or simply not knowing about them. Understanding these barriers could help design better campaigns and interventions to encourage wider adoption.
Reviewing these findings shows how a small, simple change—replacing regular salt with a potassium-based substitute—could have a big impact on public health. High blood pressure is a leading cause of heart disease and stroke, and cutting sodium is one of the easiest ways to reduce risk.
Despite this, very few Americans take advantage of salt substitutes. Raising awareness and improving access could help millions of people control their blood pressure and live healthier, longer lives.
If you care about blood pressure, please read studies that widely used blood pressure drug may increase eye disease risk and common blood pressure drugs linked to cognitive decline.
For more about blood pressure, please read studies about why checking blood pressure while lying down is very important and lowering top blood pressure number to less than 120 mm Hg effectively prevents heart disease.
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