One in three Australian adults has high blood pressure (hypertension). Excess salt (sodium) increases the risk of high blood pressure, and everyone with hypertension is advised to cut down on salt in their diet. However, despite strong recommendations over the years, it has been difficult to get Australians to reduce their salt intake. Changing cooking habits, using less salt, selecting low-salt foods, and adjusting to a less salty taste has proven challenging for many. However, a simple and effective solution has been identified: potassium-enriched salt. 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 compared to cutting salt intake, and it has been concluded in new research that clinical guidelines for hypertension should include clear recommendations to make the switch.
Potassium-enriched salts replace some of the sodium chloride in regular salt with potassium chloride. They are also known as low-sodium salt, potassium salt, heart salt, mineral salt, or sodium-reduced salt. Potassium chloride looks and tastes very similar to sodium chloride. This type of salt works to lower blood pressure not only by reducing sodium intake, but also by increasing potassium intake, which is mainly obtained from fruits and vegetables.
According to strong evidence from a randomized trial of 20,995 people, it has been found that switching to potassium-enriched salt lowers blood pressure and reduces the risks of stroke, heart attacks, and early death. An overview of 21 other studies also suggests that much of the world’s population could benefit from potassium-enriched salt. The World Health Organization’s 2023 global report on hypertension has highlighted potassium-enriched salt as an “affordable strategy” to reduce blood pressure and prevent cardiovascular events such as strokes.
The existing guidelines for managing high blood pressure across the world have been reviewed, and it has been found that they do not provide clear and consistent advice on using potassium-enriched salt. While many guidelines recommend increasing dietary potassium intake and refer to reducing sodium intake, only the Chinese and European guidelines recommend using potassium-enriched salt. Specific wording has been suggested to help guidelines reflect the latest evidence and be adopted in Australia and around the world as well.
Recommended wording for guidance about the use of potassium-enriched salt in clinical management guidelines.
Lack of awareness about salt intake and its potential health issues, as well as limited availability, have been identified as challenges to the widespread adoption of potassium-enriched salt. Although some Australian retailers stock potassium-enriched salt, it is often only one brand and is not prominently displayed. Additionally, potassium-enriched salts are generally more expensive than regular salt, but still low cost compared to most other foods and not as expensive as many fancy salts now available. Although the potential for disease prevention is significant, potassium-enriched salt is marketed in only 47 countries, mostly high-income countries, and prices vary widely.
The risk of high blood potassium levels (hyperkalemia) in the approximately 2% of the population with serious kidney disease is a commonly raised concern regarding the use of potassium-enriched salt. However, no harm from potassium-enriched salt has been recorded in any trial, although studies have been conducted in a clinical setting with specific guidance for people with kidney disease. It has been emphasized that the priority is to get people being managed for hypertension to use potassium-enriched salt because healthcare providers can advise against its use in people at risk of hyperkalemia. In some countries, the entire community is recommended to use potassium-enriched salt due to its potential large benefits, with a modeling study showing that almost half a million strokes and heart attacks would be averted every year in China if the population switched to potassium-enriched salt.
The National Hypertension Taskforce in Australia aims to improve blood pressure control rates from 32% to 70% by 2030, and potassium-enriched salt can play a key role in achieving this goal. Efforts are underway to update Australian hypertension management guidelines and to promote the new guidelines to health professionals, as well as to increase the availability of potassium-enriched salt nationwide. Potassium-enriched salt has the potential to yield similar global health gains as salt iodization, a key public health achievement from the last century. However, there is a need to expedite the switch to iodized and potassium-enriched salt in order to realize its potential on a global scale.
Xiaoyue Xu (Luna), Scientia Lecturer, UNSW Sydney; Alta Schutte, SHARP Professor of Cardiovascular Medicine, UNSW Sydney, and Bruce Neal, Executive Director, George Institute Australia, George Institute for Global HealthThis article is republished from The Conversation under a Creative Commons license. Read the original article.
