Salt substitutes named hypertension ‘gamechanger’

It is a simple swap with potentially life-changing impacts – switching out salt for a low-sodium alternative.
 
Now, a team of international experts is pleading for these potassium-enriched products to be formally recognised for their abilities to help battle Australia’s hypertension epidemic.
 
Researchers from the George Institute for Global Health are calling for a recommendation of the alternatives to be officially added to treatment guidelines to reduce patients’ salt intake at the same time as boosting their potassium.
 
The recommendation comes after experts from Australia, the United States, Japan, South Africa, and India joined forces to review 32 separate hypertension treatment guidelines released in the past decade.
 
They found all referred to sodium reduction, while many also recommended increasing dietary potassium intake, and are now calling for blood pressure guidelines to include the following ‘strong recommendation’ for patients with hypertension:
 
‘Potassium-enriched salt with a composition of approximately 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium sparing diuretic or have another contra-indication.’
 
The George Institute’s Professor Alta Schutte said despite the compelling data, patients rarely use potassium-enriched, sodium-reduced salt substitutes.
 
‘We found current clinical guidelines offer incomplete and inconsistent recommendations about the use of these salt substitutes,’ she said.
 
‘Given the wealth of evidence available, we feel it’s time to include salt substitutes in treatment guidelines to help address spiralling rates of uncontrolled high blood pressure around the world and reduce preventable deaths.
 
‘Unwanted taste effects are the main reason why efforts to reduce salt intake have failed for more than two decades. The willingness of patients to keep using potassium-enriched salt removes that barrier, which is why it can be a gamechanger.’
 
Globally, people are consuming around 4.3 grams of salt every day, but the World Health Organization has recommended this be reduced by 30% by 2025.
 
GP and researcher Professor Ralph Audehm supports the call to recommend salt alternatives, telling newsGP it provides constructive advice for patients to act on.
 
‘Some of the pushback I’ve had about the potassium-enriched salt is it’s a little bit more bitter, but it’s just another way of helping people reduce their salt intake which can have a huge impact on their blood pressure,’ he said.
 
‘I always encourage people to read labels because a lot of foods have salt in them, but they hide it with things like sweetness … I like to recommend spices, such as pepper or paprika.
 
‘We’ve become accustomed to a certain level of salt and then when you really reduce it, everything tastes terrible for a week or two, but then basically everything resets.’
 
According to the Australian Bureau of Statistics, 11.6% of Australians reported having hypertension in 2022, an increase from the previous decade.
 
Its prevalence increased with age, almost tripling between 35–44-year-olds (4.7%) to 45–54-year-olds (12.4%).
 
Professor Audehm said hypertension continues to be one of the most common conditions seen by GPs, with many patients seeking out ways to lessen their risk.
 
‘All my hypertensive patients get the talk about salt because I think it is very important,’ he said.
 
‘We should ask them to certainly try and lower their salt intake, and what sort of an impact it can have on their blood pressure.
 
‘If it’s something that they find that they can’t do, I think we then need to talk about alternatives.’
 
Moving forward, Professor Schutte and her colleagues want clinical guideline bodies to consider the recommendation ‘at the earliest opportunity’.
 
‘If the world switched from using regular salt to potassium-enriched it would prevent millions of strokes and heart attacks every year at very low cost,’ she said.
 
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cardiovascular disease hypertension