High blood pressure is often called the “silent killer” because it usually has no signs or symptoms. It happens when the force of blood pushing against the walls of your arteries stays too high for too long. This can cause serious health problems like heart attacks, strokes, and kidney damage.
In the United States, almost half of all adults—around 122 million people—had high blood pressure between 2017 and 2020. Sadly, this condition led to more than 130,000 deaths. Yet many easy ways to lower blood pressure are still not used enough.
One of the simplest ways to reduce blood pressure is to eat less salt, or sodium. Most people eat too much sodium, often without realizing it. It hides in processed foods, canned goods, and meals from restaurants. At the same time, many people don’t get enough potassium, which helps balance the effects of sodium and lower blood pressure.
Salt substitutes can help with this. These are products that replace some or all of the sodium in regular salt with potassium.
They taste very similar to normal salt, although some people say they notice a slightly bitter taste when heated. Salt substitutes are easy to find in stores and not expensive, making them a good option for many people who want to lower their blood pressure.
But a new study shows that very few Americans are using them. The research was shared at the American Heart Association’s Hypertension Scientific Sessions 2025. It found that less than 6% of U.S. adults used salt substitutes. In fact, use was highest in 2013–2014 at just 5.4%, and dropped to only 2.5% by 2020.
Even among people with high blood pressure, salt substitutes were not used much. People who had trouble controlling their blood pressure with medicine still used them very little—only between 3.7% and 7.4%. Among those who could safely use them, like people with healthy kidneys and no medications that affect potassium, the rate was just 2.3% to 5.1%.
Salt substitutes are not for everyone. Because they contain potassium, they may be risky for people with kidney problems or those taking certain medications or supplements. Too much potassium can cause dangerous heart rhythm issues. That’s why it’s important to talk to a doctor before switching to a salt substitute.
Still, for most adults with normal kidney function, salt substitutes are safe and helpful. The study’s lead author, Yinying Wei from UT Southwestern Medical Center, said that doctors should talk to patients about using salt substitutes, especially when blood pressure is hard to manage.
Another heart expert, Dr. Amit Khera from the American Heart Association, called the low use of salt substitutes “eye-opening” and said more patients and doctors should consider them.
The researchers used data from over 37,000 adults in the National Health and Nutrition Examination Survey (NHANES) collected from 2003 to 2020. They looked at salt substitute use, blood pressure, medications, and how often people ate out.
People who ate at restaurants three or more times a week were a little less likely to use salt substitutes, but this difference disappeared when other factors like age, race, and education were taken into account.
Even with some limits, the study clearly shows that salt substitute use is still very low and has not improved over the last 20 years. This shows that many people still don’t know about them, or don’t understand how they could help.
Understanding why people are not using salt substitutes—whether it’s due to taste, cost, or lack of information—could help public health experts create better campaigns and education efforts.
Small changes like using a salt substitute instead of regular salt could have a big impact. With more awareness and support, this simple change could help millions of people lower their blood pressure and live longer, healthier lives.
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