Diet, ExerCIse and CarDiovascular hEalth–Salt - DECIDE-Salt

Contribution To Literature:

The DECIDE-Salt trial showed that a salt substitute was associated with a lower incidence of hypertension without causing hypotension vs. usual salt.


The goal of the trial was to evaluate a salt substitute compared with usual salt among Chinese individuals with normal blood pressure.

Study Design

  • Randomized
  • Parallel
  • Blinded

Normotensive Chinese adults were randomized to a salt substitute group (n = 313) vs. usual salt group (n = 298). The salt substitute group consisted of 62.5% sodium chloride, 25% potassium chloride, and 12.5% dried food ingredient flavorings (mushroom, lemon, seaweed, hawthorn, wild jujube).

  • Total number of enrollees: 611
  • Duration of follow-up: 2 years
  • Mean patient age: 71 years
  • Percentage female: 26%

Inclusion criteria:

  • Normotensive Chinese adults aged ≥55 years
  • Blood pressure <140/90 mm Hg
  • Not on antihypertensive medications

Principal Findings:

The primary outcome, incident hypertension, was 11.7/100 person-years in the salt substitute group vs. 24.3/100 person-years in the usual salt group (p = 0.02).

Secondary outcomes:

  • Incident hypotension: 9.0/100 person-years in the salt substitute group vs. 9.7/100 person-years in the usual salt group (p = 0.76)
  • Net change in systolic blood pressure: -8.0 mm Hg in the salt substitute group vs. 7 mm Hg in the usual salt group


Among adult normotensive individuals, a salt substitute reduces incident hypertension without resulting in hypotension. A salt substitute enriched with potassium may be an alternative strategy to antihypertensive medications in treating pre-hypertension/mild hypertension. Further studies are warranted.


Zhang X, Yuan Y, Li C, et al. Effect of a Salt Substitute on Incidence of Hypertension and Hypotension Among Normotensive Adults. J Am Coll Cardiol 2024;83:711-22.

Editorial Comment: Olde Engberink RH. Salt Intake: Reduce or Substitute? J Am Coll Cardiol 2024;83:723-5.

Clinical Topics: Prevention, Hypertension

Keywords: Hypertension, Sodium

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