A community-based salt substitution campaign lowered blood pressure and significantly reduced new cases of hypertension, according to researchers presenting on a Peru-based study at ESC Congress 2019.

The study involved a total of 2,376 individuals from six villages in Tumbes, Peru, a region with high levels of sodium consumption and hypertension and limited knowledge of the connections between salt and risk factors like blood pressure. Half of the participants were women and the median age was 43 years. Blood pressure was measured at the beginning of the study and every five months, for a total of seven measurements. Every five months, a village was randomly selected to join the intervention – meaning all villages were in the intervention group by the final phase of the study.

Researchers used an innovative social marketing campaign to introduce a salt substitute – named Salt-Liz by the locals – containing 75 percent sodium and 25 percent potassium. As villages were chosen for the innovation portion of the trial, "Salt-Liz" was provided to households, grocery shops, community kitchens and street vendors in exchange for their own salt.

Overall results found the salt substitute reduced systolic blood pressure by an average of 1.23 mm Hg and diastolic blood pressure by an average of 0.72 mm Hg. Blood pressure reductions were even greater in individuals with hypertension at baseline, with average reductions in systolic and diastolic blood pressures at 1.74 mm Hg and 1.25 mm Hg, respectively. Of the 1,865 participants without hypertension at baseline, researchers noted the salt substitute significantly reduced the likelihood of developing hypertension by 51 percent, compared with using normal salt. At three years, urine samples from a subset of 600 participants found that while potassium levels increased, sodium levels did not change, suggesting continued use of the salt substitute post study.

According to Senior Author Jaime Miranda, MD, the intervention was simple, highly accepted, low cost and unique in that it engaged people by marketing a new product vs. pushing a behavior change. "Innovative approaches like this marketing campaign we used to introduce a salt substitute prove that changes can be introduced and sustained," he said. "The salt substitute can be used at the community level, as in our study. But it could also be adopted by food manufacturers and larger shops to nudge behavior change in a healthy direction."

Clinical Topics: Prevention, Hypertension

Keywords: ESC 19, ESC Congress, Blood Pressure, Hypertension, Primary Prevention

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