Replacing regular salt with a salt substitute in the kitchens of elderly care facilities in China reduced the incidence of hypertension without increasing episodes of hypotension among older Chinese adults with normal blood pressure (BP), according to a post hoc analysis of the DECIDE-Salt study published Feb. 12 in JACC.

DECIDE-Salt is a large, multicenter, cluster-randomized trial. The present analysis included 611 participants (mean age, 71.4 years; women, 25.7%; mean BP, 121.9/74.4 mm Hg); 313 lived in 24 facilities using salt substitute and 298 lived in 24 facilities using regular salt.

At two years, the incidence of hypertension was 11.7 per 100 people-years in participants consuming salt substitute and 24.3 per 100 people-years in participants consuming regular salt. People consuming salt substitute were 40% less likely to develop hypertension vs. those consuming regular salt. Furthermore, there was no difference in the incidence of hypotension between the two groups (9.0 vs. 9.7 per 100 people-years).

Notably, an increase in the mean systolic/diastolic BP was seen in the usual salt group (7.0/7.5 mm Hg) but essentially no change in the salt substitute group (–0.3/0.2 mm Hg) for a between-group net reduction of –8.0/–2.0 mm Hg).

"It's crucial to recognize the impact of our dietary choices on heart health and increase the public's awareness of lower-sodium options," said Yangfeng Wu, MD, PhD, lead author of the study. "Adults frequently fall into the trap of consuming excess salt through easily accessible and budget-friendly processed foods."

In an accompanying editorial comment, Rik H.G. Olde Engberink, MD, PhD, notes that the salt substitute was given to kitchen staff during the trial and the centers were restricted from providing externally sourced food to residents more than once per week. "This approach potentially has a greater impact on blood pressure outcomes," Engberink writes. "And for this reason, salt substitutes should be adopted early in the food chain by the food industry so that the sodium-potassium ratio of processed foods will improve."

Clinical Topics: Prevention, Hypertension

Keywords: Hypertension, Sodium