High blood pressure is one of the most common health problems in the United States and around the world.
Often called the “silent killer,” it usually causes no obvious symptoms but can quietly damage the body for years.
Over time, uncontrolled high blood pressure can increase the risk of heart attacks, strokes, heart failure, kidney disease, and other serious health conditions.
According to national health data collected between 2017 and 2020, nearly 122 million adults in the United States were living with high blood pressure. The condition contributed to more than 130,000 deaths during that period.
Because of its enormous impact on public health, researchers continue to search for simple and affordable ways to help people keep their blood pressure under control.
A new study presented at the American Heart Association’s Hypertension Scientific Sessions 2025 suggests that one such solution may already be available but is not being widely used. The research found that salt substitutes, which can help lower blood pressure, are used by fewer than 6% of adults in the United States.
Blood pressure is affected by many factors, including diet. Two minerals play especially important roles: sodium and potassium. Sodium, which is found in table salt and many processed foods, can raise blood pressure when consumed in large amounts. Potassium has the opposite effect. It helps relax blood vessels and supports healthy blood pressure levels.
For this reason, health experts often recommend reducing sodium intake while increasing potassium intake. Salt substitutes offer a practical way to achieve both goals at the same time.
Unlike regular table salt, which is made mostly of sodium chloride, salt substitutes replace some or all of the sodium with potassium chloride.
The result is a product that tastes similar to ordinary salt while containing much less sodium. Although some people notice a slightly bitter taste, especially when the substitute is heated during cooking, many find it to be an acceptable alternative.
Previous research has shown that replacing regular salt with potassium-enriched substitutes can lower blood pressure and may even reduce the risk of heart disease and stroke. Because they are relatively inexpensive and easy to use, salt substitutes are considered one of the simplest dietary changes people can make to improve heart health.
Despite these potential benefits, the new study found that very few Americans are taking advantage of them.
The research was led by Yinying Wei, a doctoral student at UT Southwestern Medical Center in Dallas. The team analyzed data from the National Health and Nutrition Examination Survey, a large government health database that collects information from people across the United States.
The researchers examined information from 37,080 adults between 2003 and 2020. They wanted to understand how often people used salt substitutes and whether certain groups were more likely to use them.
The results showed that overall use remained extremely low. Fewer than 6% of adults reported using salt substitutes.
Usage was slightly higher among people whose blood pressure was being treated with medication and among those whose blood pressure remained high despite treatment. However, even in these groups, adoption rates were still very low.
The researchers also looked at eating habits. They found that people who ate restaurant meals more than three times a week were generally less likely to use salt substitutes at home. However, after adjusting for factors such as age, income, and race, this difference was no longer statistically significant.
Perhaps the most surprising finding involved people who could safely use salt substitutes. Among adults with healthy kidney function who were not taking medications that affect potassium levels, only about 2.3% to 5.1% reported using these products. This means that millions of people who might benefit from salt substitutes are not currently using them.
The findings suggest that there may be a major missed opportunity to improve blood pressure control through simple dietary changes.
However, experts caution that salt substitutes are not suitable for everyone. Because these products contain more potassium than regular salt, some people can develop excessively high potassium levels if they use them. This condition, known as hyperkalemia, can be dangerous and may cause abnormal heart rhythms.
People with kidney disease are especially at risk because their kidneys may not be able to remove excess potassium efficiently. Certain medications and potassium supplements can also increase potassium levels. For these reasons, health experts recommend speaking with a healthcare provider before switching to a salt substitute.
Wei noted that healthcare professionals could play an important role in increasing awareness. Doctors, nurses, dietitians, and pharmacists may be able to educate patients about when salt substitutes are appropriate and how to use them safely.
The researchers believe more work is needed to understand why salt substitute use remains so low. Possible reasons may include concerns about taste, lack of awareness, limited availability, or uncertainty about safety.
Future studies may help identify these barriers and develop strategies to encourage wider adoption among people who could benefit.
The findings highlight how small changes in daily habits can have a meaningful impact on health. While medications remain important for many people with hypertension, simple adjustments in the kitchen may provide an additional tool for improving blood pressure control and reducing the risk of heart disease.
If you care about high blood pressure, please read studies about unhealthy habits that may increase high blood pressure risk, and drinking green tea could help lower blood pressure.
For more information about high blood pressure, please see recent studies about what to eat or to avoid for high blood pressure, and 12 foods that lower blood pressure.
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