Salt substitutes are a simple and effective way to lower blood pressure, yet very few people with high blood pressure are using them.
This finding comes from a new study presented at the American Heart Association’s Hypertension Scientific Sessions 2025.
Researchers found that over the past two decades, salt substitute use has stayed low, even among people with high blood pressure who could benefit the most.
High blood pressure, also known as hypertension, happens when the force of blood pushing through blood vessels stays too high over time.
It can lead to serious health problems like heart attacks, strokes, and kidney disease.
In the U.S., nearly half of all adults—over 120 million people—have high blood pressure, and it played a role in more than 130,000 deaths between 2017 and 2020. One of the main causes of high blood pressure is eating too much sodium and not enough potassium.
Salt substitutes replace some or all of the sodium in regular salt with potassium. While they taste almost the same, they can be a healthier option for people trying to manage their blood pressure.
However, according to this study, less than 6% of U.S. adults reported using them. Among people with high blood pressure, usage was slightly higher, especially among those taking medication, but still low overall.
The study was led by Yinying Wei, a Ph.D. candidate at UT Southwestern Medical Center. Using national health data from 2003 to 2020, the team looked at how many people reported using salt substitutes.
The findings were concerning: even in people with difficult-to-control high blood pressure, most still used regular salt. Usage peaked at just over 5% in 2013-2014 and then dropped to 2.5% before the COVID-19 pandemic disrupted data collection.
The researchers also found that even among people who were considered eligible to use salt substitutes—those with normal kidney function and not taking medications that affect potassium levels—very few made the switch.
This is important because while potassium is generally healthy, too much can be dangerous for people with kidney problems or those taking certain medications. That’s why it’s important to talk to a doctor before using potassium-based salt substitutes.
Eating habits also played a role. People who ate at restaurants three or more times a week were less likely to use salt substitutes, although this link became weaker when adjusted for age, race, education, and health insurance.
Experts say this is a missed opportunity. Salt substitutes are cheap and easy to use, and cutting back even a small amount of sodium each day can have a big impact on blood pressure.
The American Heart Association recommends no more than 2,300 milligrams of sodium per day, and ideally less than 1,500 mg for most adults. Reducing sodium by just 1,000 mg daily can already lead to improvements in heart health.
One challenge is that many people don’t realize how much sodium they’re getting. Most sodium in the American diet doesn’t come from table salt—it comes from packaged foods and meals eaten outside the home. Even so, switching to a lower-sodium option at home could make a difference.
The study had some limits. For example, salt use was self-reported, so people may not have remembered exactly what type of salt they used. Also, the researchers couldn’t separate potassium-enriched substitutes from other salt types in the data. Still, the message is clear: very few people are using this simple tool to improve their health.
Experts hope future studies will explore why salt substitutes remain unpopular. It could be due to taste, cost, or lack of awareness. Understanding the reasons could help doctors and public health officials guide more people toward better choices.
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