Few Americans with high blood pressure are using salt substitutes, even though these products are an easy and effective way to reduce sodium intake and manage blood pressure.
This finding comes from a new study presented at the American Heart Association’s Hypertension Scientific Sessions 2025.
High blood pressure happens when blood pushes too hard against the walls of arteries. It increases the risk of heart attack, stroke, and kidney disease. About 122 million U.S. adults had high blood pressure between 2017 and 2020, contributing to over 130,000 deaths. Diets high in sodium and low in potassium increase the risk.
“Only about 6% of U.S. adults use salt substitutes,” said lead author Yinying Wei, Ph.D. candidate at UT Southwestern Medical Center. “These are low-cost tools to help control blood pressure, especially in patients with hard-to-treat hypertension.”
Salt substitutes often replace sodium with potassium. While they taste like regular salt, some may have a bitter aftertaste when heated. The American Heart Association recommends no more than 2,300 mg of sodium daily—ideally under 1,500 mg. Cutting 1,000 mg per day can improve heart health.
This study used data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020. Researchers focused on adults with high blood pressure and those eligible to safely use salt substitutes (e.g., with normal kidney function and not on medications that increase potassium).
Key findings include:
Salt substitute use peaked at 5.4% in 2013–2014 but fell to 2.5% by 2020. Among eligible adults, only 2.3%–5.1% used them. Usage was highest in people with treated high blood pressure (up to 10.5%).
Use remained below 5.6% in people with untreated or normal blood pressure. People who ate out frequently were slightly less likely to use salt substitutes.
Wei emphasized that many people still use regular salt, even those with poorly managed or untreated high blood pressure. Experts believe health care providers should talk more about salt substitutes with patients.
“Salt substitutes are a simple, often overlooked way to improve blood pressure,” said Dr. Amit Khera, a heart specialist at UT Southwestern, who was not part of the study.
The study had limitations. Salt substitute use was self-reported, and all substitute types were grouped together. The survey didn’t measure how much was used either.
Future research should examine why usage remains low, including issues like taste, price, and awareness. Better understanding could help develop more effective strategies to increase adoption.
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