Salt Substitute Use Remains Rare Among US Adults With Hypertension, Two-Decade Survey Finds

Yinying Robyn Wei, MCN, RDN

Courtesy of David Gresham

Despite evidence that potassium-enriched salt substitutes can lower sodium intake and improve blood pressure control, use of these products among U.S. adults with hypertension has remained consistently low, according to findings presented September 4, 2025, at the American Heart Association (AHA) Hypertension Scientific Sessions in Baltimore, Maryland.

Investigators analyzed data from 37 080 adults aged ≥18 years who participated in the National Health and Nutrition Examination Survey (NHANES) between 2003 and March 2020. Participants were categorized by hypertension status and treatment: controlled hypertension with medication, uncontrolled hypertension despite medication, untreated hypertension, and normotension. An additional subgroup analysis evaluated individuals eligible to use salt substitutes, defined as those with normal kidney function and not taking medications or supplements affecting potassium levels.

Salt use was classified as ordinary salt (eg, iodized, sea, kosher), salt substitutes (potassium-enriched or other formulations), or no salt.

Overall, fewer than 6% of U.S. adults reported using salt substitutes at any point during the study period. Use peaked at 5.4% in 2013–2014 but declined to 2.5% by 2017–2020. Among adults eligible for salt substitute use, prevalence ranged from 2.3% to 5.1%.

In subgroup analyses, usage was highest among participants with treated, controlled hypertension (3.6%–10.5%) and those with treated but uncontrolled hypertension (3.7%–7.4%). Among individuals with untreated hypertension or normal blood pressure, use remained consistently below 5.6%.

Participants who reported eating at restaurants three or more times per week were less likely to use salt substitutes, although this association was not significant after adjusting for demographic and socioeconomic variables.

Lead author Yinying Wei, MCN, RDN, LD, PhD candidate at UT Southwestern Medical Center, noted that “overall, less than 6% of all U.S. adults use salt substitutes, even though they are inexpensive and can be an effective strategy to help people control blood pressure.” Wei added that clinicians can raise awareness about safe use, especially in patients with resistant hypertension.

Salt substitutes replace some or all sodium chloride with potassium chloride. While beneficial for most adults, excessive potassium intake can be harmful for individuals with impaired kidney function or those taking certain medications.

AHA volunteer expert Amit Khera, MD, MSc, who was not involved in the study, commented that the persistently low use of salt substitutes represents “an important and easily missed opportunity to improve blood pressure in the U.S.”

Limitations. The study relied on self-reported dietary data, which may underestimate use or misclassify products. The analysis did not distinguish potassium-based substitutes from other types, nor did it quantify consumption amounts.

Researchers emphasized the need for future studies to explore barriers to adoption, including taste, cost, and awareness among both patients and clinicians.

Reference: Wei Y, et al. U.S. survey finds salt substitutes rarely used by people with high blood pressure. Presented at: American Heart Association Hypertension Scientific Sessions; September 4, 2025; Baltimore, MD. Poster #TAC228.