Study Finds Low Adoption of Salt Substitutes Among Americans With High Blood Pressure

Salt substitutes were rarely used by people with high blood pressure despite their effectiveness in lowering sodium intake and managing blood pressure, according to a review of almost 20 years of U.S. health survey data presented at the American Heart Association's Hypertension Scientific Sessions 2025. The study, which analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020, found that overall less than 6% of all U.S. adults use salt substitutes.

High blood pressure affects 122.4 million (46.7%) adults in the U.S. and contributes to more than 130,000 deaths annually. Too much sodium and too little potassium in the diet are known risk factors for high blood pressure. Salt substitutes are products that replace some or all of the sodium with potassium, offering a simple and inexpensive strategy to help control blood pressure, particularly for individuals with difficult-to-treat or treatment-resistant hypertension.

The analysis revealed that salt substitute use among all U.S. adults remained low, peaking at 5.4% in 2013-2014 before falling to 2.5% by 2017-March 2020. Among adults eligible to use salt substitutes—those with normal kidney function and not taking medications or supplements that affect blood potassium levels—only 2.3% to 5.1% did so. Usage was highest in people with high blood pressure whose blood pressure was controlled with medications (3.6%-10.5%), followed by those with uncontrolled hypertension despite medications (3.7%-7.4%).

Lead study author Yinying Wei, M.C.N., R.D.N., L.D., and Ph.D. candidate at UT Southwestern Medical Center in Dallas, stated that health care professionals can raise awareness about the safe use of salt substitutes by having conversations with their patients who have persistent or hard-to-manage high blood pressure. The American Heart Association recommends consuming no more than 2,300 mg of sodium daily, with an ideal limit of less than 1,500 mg per day for most adults, especially those with high blood pressure. More information about sodium limits can be found at https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium.

Amit Khera, M.D., M.Sc., FAHA, an American Heart Association volunteer expert, noted that the study highlights an important and easy missed opportunity to improve blood pressure in the U.S. The fact that use of salt substitutes remains so low and has not improved in two decades reminds patients and health care professionals to discuss the use of these substitutes, particularly in visits focused on high blood pressure. Additional resources on blood pressure management are available at https://www.heart.org/en/health-topics/high-blood-pressure.

The study has several limitations, including self-reported information about salt substitute use that may have led to underreporting or misclassification. Future research should explore why salt substitute use remains low by investigating potential barriers such as taste acceptance, cost, and limited awareness among both patients and clinicians. These insights may help guide more targeted interventions to address this significant public health opportunity.