Millions of adults in the United States have high blood pressure, a condition that can lead to serious health problems like heart attacks and strokes.
Yet, a recent study presented at the American Heart Association’s Hypertension Scientific Sessions 2025 has revealed that very few people with high blood pressure are using salt substitutes—even though they are an easy and affordable way to lower sodium intake and manage blood pressure more effectively.
High blood pressure happens when the force of blood against artery walls stays too high over time. According to data from 2017 to 2020, about 122.4 million U.S. adults—almost 47%—had high blood pressure, and the condition contributed to more than 130,000 deaths.
Eating too much sodium and not enough potassium are both known to raise the risk of high blood pressure.
Salt substitutes are products that swap some or all of the sodium in regular salt with potassium. Potassium-enriched salt tastes similar to regular salt, although it may have a bitter aftertaste when heated.
The American Heart Association recommends adults aim for less than 2,300 milligrams of sodium per day—and ideally under 1,500 milligrams for people with high blood pressure. For most, cutting sodium by even 1,000 milligrams per day can help improve heart health.
Despite the potential benefits, the new study shows that salt substitute use is still extremely rare. Led by Yinying Wei, a Ph.D. candidate at UT Southwestern Medical Center, the study analyzed nearly 20 years of data from the National Health and Nutrition Examination Survey (NHANES), covering the years 2003 to 2020.
The research found that overall, fewer than 6% of adults used salt substitutes, with the number peaking at 5.4% in 2013-2014, then dropping to 2.5% by early 2020.
Even among people eligible to use salt substitutes—those with healthy kidney function and not taking medications that affect potassium levels—usage was between only 2.3% and 5.1%. Among people with high blood pressure, usage was still low, even in those taking medication.
Those with treated but poorly controlled blood pressure used salt substitutes the most, ranging from 3.7% to 10.5%, but this is still a small number. People with untreated high blood pressure or normal blood pressure had even lower usage rates, mostly under 5.6%.
The study also looked at lifestyle habits, like how often people ate at restaurants. While adults who dined out three or more times a week were less likely to use salt substitutes, this difference disappeared after considering other factors like age, race, education, and insurance.
Salt substitutes aren’t safe for everyone. People with kidney disease or those on certain medications should avoid them, because too much potassium can be dangerous and cause irregular heartbeats. That’s why anyone considering switching to a salt substitute should talk with a doctor first.
One limitation of the study is that salt substitute use was self-reported, so people might not have remembered correctly. The study also couldn’t separate out different types of salt substitutes, such as those with or without potassium. Finally, it didn’t track how much salt substitute people were actually using.
Even so, the findings are striking. “Salt substitute use remained uncommon over the last two decades including among people with high blood pressure,” said Wei. “Even among individuals with treated and poorly managed or untreated high blood pressure, most continued to use regular salt.”
Experts say that needs to change. Dr. Amit Khera, a cardiologist at UT Southwestern Medical Center, called the findings “eye-opening” and said they point to a missed opportunity to improve blood pressure control through a simple strategy.
Wei recommends that doctors talk to patients with high blood pressure about using salt substitutes safely. She also believes that more research is needed to understand why so few people are using these products. Taste, cost, and lack of awareness could all play a role.
In summary, salt substitutes could be a simple and effective tool in the fight against high blood pressure. But despite being available for decades, they are still not widely used. With greater awareness and better conversations between doctors and patients, that may begin to change.
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