A comprehensive analysis of nearly two decades of U.S. health survey data reveals that salt substitutes remain significantly underutilized among Americans with high blood pressure, despite their proven effectiveness in reducing sodium intake and managing hypertension. The study, presented at the American Heart Association's Hypertension Scientific Sessions 2025, found that overall salt substitute usage among all U.S. adults peaked at just 5.4% in 2013-2014 before declining to 2.5% by 2017-2020.
Researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2020, examining the use of products that replace salt with potassium-enriched or other alternative salts. The investigation specifically focused on people with high blood pressure, a condition affecting 122.4 million (46.7%) U.S. adults according to 2017-2020 data, which contributes to more than 130,000 deaths annually. High blood pressure occurs when blood force against vessel walls remains consistently elevated, increasing risks for serious events such as heart attack and stroke.
Among adults eligible to use salt substitutes—those with normal kidney function and not taking medications affecting blood potassium levels—only 2.3% to 5.1% actually utilized these products. Usage was highest among people whose blood pressure was controlled with medications (3.6%-10.5%), followed by those with uncontrolled hypertension despite medication (3.7%-7.4%). Salt substitute use remained consistently below 5.6% among individuals with untreated high blood pressure and those with normal blood pressure.
Lead study author Yinying Wei, a Ph.D. candidate at UT Southwestern Medical Center, emphasized the missed opportunity: "Overall, less than 6% of all U.S. adults use salt substitutes, even though they are inexpensive and can be an effective strategy to help people control blood pressure, especially people with difficult-to-treat high blood pressure." Salt substitutes typically replace sodium with potassium, though potassium salt can develop a bitter aftertaste when heated. The American Heart Association recommends consuming no more than 2,300 mg of sodium daily, with an ideal limit under 1,500 mg for most adults, particularly those with hypertension.
The study also examined dining habits and found that adults who ate at restaurants three or more times weekly appeared less likely to use salt substitutes compared to those dining out less frequently, though this difference became statistically insignificant after accounting for demographic factors. Most sodium intake comes from processed and packaged foods and restaurant meals rather than natural food sources.
Dr. Amit Khera, an American Heart Association volunteer expert not involved in the study, called the findings "eye-opening," noting that the persistently low usage over two decades represents "an important and easy missed opportunity to improve blood pressure in the U.S." Researchers recommend that healthcare professionals increase awareness about the safe use of salt substitutes through patient conversations, particularly for individuals with persistent or hard-to-manage hypertension. Future research should explore barriers to adoption, including taste acceptance, cost, and limited awareness among both patients and clinicians.
