This salt alternative could help reduce blood pressure. So why are so few people using it?

• Excess salt (sodium) increases the risk of high blood pressure so everyone with hypertension is advised to reduce salt in their diet.
• It can be used just like regular salt and most people don’t notice any important difference in taste.
• Switching to potassium-enriched salt is feasible in a way that cutting salt intake is not.

What is potassium-enriched salt?

• Potassium-enriched salts replace some of the sodium chloride that makes up regular salt with potassium chloride.
• They’re also called low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt.

What is the evidence?

We have strong evidence from a randomised trial of 20,995 people that switching to potassium-enriched salt lowers blood pressure and reduces the risks of stroke, heart attacks and early death. The participants had a history of stroke or were 60 years of age or older and had high blood pressure.
An overview of 21 other studies suggests much of the world’s population could benefit from potassium-enriched salt. The World Health Organisation’s 2023 global report on hypertension highlighted potassium-enriched salt as an “affordable strategy” to reduce blood pressure and prevent cardiovascular events such as strokes.

What should clinical guidelines say?

• We teamed up with researchers from the United States, Australia, Japan, South Africa and India to review 32 clinical guidelines for managing high blood pressure across the world.
• While many guidelines recommend increasing dietary potassium intake, and all refer to reducing sodium intake, only two guidelines – the Chinese and European – recommend using potassium-enriched salt.

Why do so few people use it?

• Few people know a simple switch to potassium-enriched salt can help lower blood pressure and reduce the risk of a stroke and heart disease.
• Several Australian retailers stock potassium-enriched salt but there is usually only one brand available, and it is often on the bottom shelf or in a special food aisle.

A 2021 review found potassium-enriched salts were marketed in only 47 countries and those were mostly high-income countries. Prices ranged from the same as regular salt to almost 15 times greater. Even though generally more expensive, potassium-enriched salt has the potential to be highly cost effective for disease prevention.

Preventing harm

• People with serious kidney disease are already advised to avoid regular salt and to avoid foods high in potassium.
• No harm from potassium-enriched salt has been recorded in any trial done to date, but all studies were done in a clinical setting with specific guidance for people with kidney disease.
• In some countries, potassium-enriched salt is recommended to the entire community because the potential benefits are so large.

What will happen next?

• We are working with the taskforce to update Australian hypertension management guidelines, and to promote the new guidelines to health professionals.
• The next switch to iodised and potassium-enriched salt offers at least the same potential for global health gains.
• But we need to make it happen in a fraction of the time.

• Alta Schutte receives funding from the National Health and Medical Research Council of Australia, the Medical Research Future Fund, and NSW Health.
• She is Company Secretary of the Australian Cardiovascular Alliance, Board Member of Hypertension Australia, and Co-Chair of the National Hypertension Taskforce of Australia.