Using Salt Substitutes Led to 40% Drop in High Blood Pressure Risk


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Eating too much salt is a known risk factor for developing high blood pressure. Nadine Greeff/Stocksy United
  • Potassium-enriched salt substitutes did not increase the risk of high blood pressure in older adults, a new study found.
  • Reducing sodium in the diet is one of the most effective ways to lower the risk of high blood pressure, but it can be challenging for people to do consistently
  • In the study, a salt substitute didn’t increase the risk of low blood pressure episodes, which can increase the chance of older adults falling and injuring themselves.

Replacing regular table salt with a potassium-enriched salt substitute reduced the development of high blood pressure in older adults without leading to episodes of low blood pressure, a new study found.

Nearly half of adults in the United States have high blood pressure, increasing their risk of heart disease and stroke, according to the Centers for Disease Control and Prevention.

Cutting back on sodium in the diet is one of the most effective ways to reduce the risk of high blood pressure.

But it can be challenging due to the effect that sodium has on the taste of food, and the high amounts of sodium in many packaged foods and restaurant or fast food meals.

“Our results showcase an exciting breakthrough in maintaining blood pressure that offers a way for people to safeguard their health and minimize the potential for cardiovascular risks, all while being able to enjoy the perks of adding delicious flavor to their favorite meals,” study author Dr. Yangfeng Wu, executive director of Peking University Clinical Research Institute in Beijing, China, said in a news release.

The study was published Feb. 12 in the Journal of the American College of Cardiology.

Normal blood pressure is less than 120 mm Hg/80 mm Hg. A systolic blood pressure between 120 and 129 (with a diastolic pressure less than 80 mm Hg) is considered elevated or prehypertensive.

Stage 1 high blood pressure is defined as:

  • systolic blood pressure (top number in a blood pressure reading) greater than 130mm Hg
  • diastolic blood pressure (bottom number in a blood pressure reading) greater than 80 mm Hg

Stage 2 high blood pressure is defined as:

  • systolic blood pressure (top number in a blood pressure reading) greater than 140mm Hg
  • diastolic blood pressure (bottom number in a blood pressure reading) greater than 90 mm Hg

The study included 611 people 55 years or older living in 48 long-term care facilities in China. The average age of participants was 71 years old, and three-quarters were men.

To be included the participants could not have blood pressure readings above 140mmHg/90mmHg and could not be taking high blood pressure medications at the start of the study.

Researchers randomly assigned half of the facilities to replace regular salt with a salt substitute, with the rest continuing to use regular salt.

Typical table salt is almost entirely sodium chloride. It may also contain iodine (for thyroid health) and, in the case of sea salt, trace amounts of other minerals. The salt substitute used in the study contained around one-third less sodium chloride than table salt.

The salt substitute also contained 25% potassium chloride — which doesn’t raise blood pressure — and 12% dried food flavorings such as mushroom, lemon, seaweed, hawthorn, and wild jujube, as well as traces of amino acids.

“By mimicking the taste of sodium without its adverse effects, salt substitutes provide a valuable tool for adhering to dietary restrictions and promoting better health outcomes,” said Dr. Maria Carolina Delgado-Lelievre, an assistant professor of medicine at the University of Miami’s Miller School of Medicine at UHealth, The University of Miami Health System, who was not involved in the new research.

After two years, people using the salt substitute were 40% less likely to develop high blood pressure compared to those using regular salt, researchers found.

In addition, people using the salt substitute did not have an increased risk of low blood pressure episodes, or hypotension.

Older adults are more susceptible to hypotension, the authors wrote, because they often have multiple chronic health problems, and may be taking medications for hypertension or other conditions that lower their blood pressure.

Low blood pressure increases the risk of falls in older adults, which can lead to injuries and death.

“The findings imply that incorporating salt substitutes into one’s diet could potentially reduce the risk of developing hypertension and associated cardiovascular diseases … without introducing additional health risks,” Delgado-Lelievre told Healthline.

Wu said in the release that a salt substitute could be extremely beneficial to people already battling with high blood pressure.

“Thus, [the use of salt substitutes is] a desirable population strategy for prevention and control of hypertension and cardiovascular disease,” he said.

However, Delgado-Lelievre cautions against applying the results of this study to people with existing high blood pressure.

“Further research targeting individuals with high blood pressure specifically is needed to fully understand the potential benefits of salt substitution in this group,” she said.

The study had several limitations, such as the study outcomes were not specified before the start of the study. The findings, though, fit with those of the parent study and what is currently known about salt substitutes and blood pressure, the researchers said.

In addition, researchers were not able to follow all participants for the entire two years, so a “significant proportion” of blood pressure measurements were missing. However, these missing values occurred at random, they wrote, and multiple analyses supported the robustness of the results.

While individuals can choose to use salt substitutes, Delgado-Lelievre said wider adoption of these products will require collaboration among public health authorities, food manufacturers, and consumers.

Education campaigns targeted at consumers and policy initiatives can also encourage the use of salt substitutes among different consumer groups, she said.

“By raising awareness and providing access to alternatives, these efforts have the potential to make a significant impact on hypertension prevention and overall cardiovascular health,” she added.

Salt substitutes, though, are not the only way to reduce sodium in your diet. Here are a few other ideas:

  • Read and compare nutrition facts labels, and choose products with the lowest amount of sodium per serving.
  • Be wary of condiments and salad dressings, which are often loaded with sodium. Look for reduced sodium or lower-sodium versions instead, or make your own low-sodium salad dressing.
  • Choose canned vegetables with no salt added, and buy frozen vegetables without high-salt sauces.
  • Use flavorful ingredients when cooking, such as herbs, spices, onions, garlic, citrus and vinegar. These can often replace some or all of the salt in a recipe.
  • Roast vegetables to bring out their natural flavors. This can even be done for vegetables that will be added to soups or stews.
  • When eating at restaurants, look for low-salt options and ask for your meal to be made without extra salt. Also, ask for sauces, dressings and gravies to be served on the side, and use sparingly.

In a study of older adults living in long-term care, researchers randomly assigned facilities to use either a potassium-rich salt substitute or regular salt.

After two years, those who used a salt substitute had a 40% lower risk of developing high blood pressure compared to those using regular salt.

Use of a salt substitute also didn’t increase the chances of people having a low blood pressure episode, which is linked to a higher risk of fall injuries and dying among older adults.



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