- Fewer than one in 20 adults with high blood pressure use salt substitutes to cut sodium.
- Uncontrolled blood pressure can harm your heart, brain and kidneys over time.
- Salt substitutes are easy to find in stores but remain an underused tool for BP control
Salt substitutes may be an easy way to cut back on sodium, but a new study shows that Americans rarely use them.
The findings, presented at the American Heart Association’s Hypertension Scientific Sessions, raise questions about why such a simple dietary swap remains uncommon—and whether health professionals should be talking about it more often with patients.
Hypertension, or high blood pressure, is one of the most common health problems in the United States. Nearly half of U.S. adults—about 120 million people—have the condition. Hypertension is defined as blood pressure above 130/80 mm Hg or the use of medication to control it.
Despite the availability of medications and lifestyle changes, fewer than one in four adults with hypertension have their blood pressure under control. That gap points to the need for practical, everyday tools to help people manage the condition. Because cutting back on sodium is a well-known strategy, researchers set out to see how often Americans turn to salt substitutes.
How Was the Study Conducted?
Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES), a long-running program that tracks the health and dietary habits of U.S. adults. For this study, they reviewed responses from more than 37,000 people collected between 2003 and 2020. Participants were asked what type of salt they used, with answers grouped into three categories: ordinary salt (such as iodized, sea, or kosher), a salt substitute (including potassium-enriched products) or no salt use at all.
The main focus was on people with high blood pressure, with additional analyses conducted among adults considered eligible to use salt substitutes—those with healthy kidney function and not taking medications or supplements that affect potassium levels. Researchers also looked at how often participants reported eating at restaurants to see if that influenced their likelihood of using a salt substitute.
What Did the Study Find?
Overall, salt substitute use was uncommon. It reached a high of 5.4% in 2013 to 2014 but slipped to just 2.5% in early 2020, when data collection stopped because of the COVID-19 pandemic.
Even among adults considered eligible to use salt substitutes—those with normal kidney function and not taking medications that affect potassium—the numbers stayed low, ranging from 2.3% to 5.1%.
Use was highest in people with high blood pressure who were taking medication and had their condition under control, at 3.6% to 10.5%. Rates were a little lower among those whose blood pressure remained uncontrolled despite treatment (3.7% to 7.4%).
By comparison, salt substitute use rarely topped 5.6% among adults with untreated hypertension or those with normal blood pressure.
The researchers also looked at eating habits. Adults who dined out three or more times a week seemed less likely to use salt substitutes than those who ate out less often—but that difference disappeared once factors such as age, race and ethnicity, education and insurance status were taken into account.
How Does This Apply to Real Life?
Salt substitutes are designed to taste like table salt but with less sodium. Many replace some or all of the sodium chloride with potassium chloride, which can help lower blood pressure by both reducing sodium and boosting potassium. They’re sold in most grocery stores, and for many people they can be a simple way to season food at home while supporting heart health.
But salt substitutes aren’t for everyone—people with kidney disease or those taking certain medications need to be cautious, since too much potassium can be harmful. For anyone unsure, it’s best to check with a health care professional first.
Even if a salt substitute isn’t the right fit, there are plenty of other ways to cut back on sodium without sacrificing flavor. Cooking with fresh or dried herbs, spices like cumin or paprika, citrus juice and zest, garlic, onion, vinegar or salt-free seasoning blends are all ways to add zest to your meals. These small changes in the kitchen can make a meaningful difference in blood pressure control over time.
Our Expert Take
The study underscores how rarely salt substitutes, which may help manage hypertension, are used in the U.S., though controlling blood pressure is key to reducing the risk of heart disease, stroke and kidney problems. Because most sodium in the U.S. diet comes from packaged and restaurant foods, cutting back takes more than just swapping the salt shaker. Salt substitutes can help some people but pairing them with home cooking, careful label reading and consultation with a healthcare provider offers a stronger path to healthier blood pressure.
