Can these salt substitutes prevent complications of hypertension?
This study suggests the blood pressure–lowering effects of potassium-enriched salt substitutes may reduce cardiovascular morbidity and mortality.
PRACTICE CHANGER
Consider recommending potassium-enriched salt substitutes for appropriate patients with hypertension to reduce blood pressure (BP) and risk for related cardiovascular (CV) events or mortality.
STRENGTH OF RECOMMENDATION
A: Based on a systematic review and meta-analysis of controlled trials. 1
Yin X, Rodgers A, Perkovic A, et al. Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis. Heart . 2022;108:1608-1615. doi: 10.1136/heartjnl-2022-321332
Only 2 of the studies in the systematic review explicitly reported the adverse effect of hyperkalemia, and there was no statistical difference in events between randomized groups. Eight other studies reported no serious adverse events related to hyperkalemia , and 11 studies did not report on the risk for hyperkalemia.
WHAT’S NEW
High-quality data demonstrate beneficial outcomes
Previous observational and interventional studies demonstrated a BP-lowering effect of salt substitutes, but limited data with poor-quality evidence existed for the impact of salt substitutes on clinical outcomes such as mortality and CV events. This systematic review and meta-analysis suggests that potassium-supplemented salt may reduce BP and secondarily reduce the risk for CV events, CV mortality, and total mortality, without clear harmful effects reported.
CAVEATS
Some patient populations, comorbidities excluded from study
The study did not include patients with kidney disease or those taking potassium-sparing diuretics. Furthermore, the available data do not include primary prevention participants.
Subgroup analyses should be interpreted with caution due to the small number of trials available for individual subgroups. In addition, funnel plot asymmetry for studies reporting DBP suggests at least some effect of publication bias for that outcome.
Although BP reduction due to salt substitutes may be small at an individual level, these levels of reduction may be important at a population level.
CHALLENGES TO IMPLEMENTATION
For appropriate patients, no challenges anticipated
There are no significant challenges to implementing conclusions from this study in the primary care setting. Family physicians should be able to recommend potassium-enriched salt substitutes to patients with hypertension who are not at risk for hyperkalemia, including those with kidney disease, on potassium-sparing diuretics, or with a history of hyperkalemia/hyperkalemic conditions. Salt substitutes, including potassium-enriched salts, are readily available in stores.
