Research shows that easily changing diet can reduce blood pressure and heart attacks: ScienceAlert

One in three Australian adults has high blood pressure (hypertension). Excess salt (sodium) increases the risk of high blood pressure, so every person with high blood pressure is advised to reduce salt in their diet.

But despite decades of strong recommendations, we have failed to convince Australians to reduce their consumption. It is difficult for people to change the way they cook, season their food differently, choose low-salt foods from supermarket shelves, and accept a less salty taste.

Now there is a simple and effective solution: potassium-rich salt. It can be used just like regular salt and most people don’t notice any significant difference in taste.

Switching to potassium-rich salt is possible in a way that reducing salt intake is not possible. Our new research concludes that clinical guidelines for hypertension should give patients clear recommendations for switching.

What is potassium rich salt?

Potassium-rich salts replace some of the sodium chloride that makes up regular salt with potassium chloride. It is also called low sodium salt, potassium salt, heart salt, mineral salt, or reduced sodium salt.

Potassium chloride looks like sodium chloride and tastes very similar.

Potassium-rich salt lowers blood pressure not only because it reduces sodium intake but also because it increases potassium intake. A lack of potassium, most of which comes from fruits and vegetables, is another big cause of high blood pressure.

what is the evidence?

We have strong evidence from a randomized trial in 20,995 people that switching to potassium-rich salt lowers blood pressure and reduces the risk of stroke, heart attack and premature death. Participants had a history of stroke or were aged 60 years or older and had high blood pressure.

An overview of 21 other studies suggests that much of the world’s population could benefit from potassium-rich salt.

The World Health Organization’s 2023 global report on high blood pressure highlighted potassium-rich salt as an “affordable strategy” for lowering blood pressure and preventing cardiovascular diseases such as strokes.

What should clinical guidelines say?

We collaborated with researchers from the United States, Australia, Japan, South Africa and India to review 32 clinical guidelines for the management of hypertension worldwide. Our findings are published today in the American Heart Association’s journal Hypertension.

We have found that current guidelines do not provide clear and consistent advice on the use of potassium-rich salt.

While many guidelines recommend increasing dietary potassium intake, and all suggest limiting sodium intake, only two guidelines—Chinese and European—recommend the use of potassium-rich salt.

To help reflect the guidelines of the latest evidence, we have proposed specific wording that could be adopted in Australia and around the world:

Why do so few people use it?

Most people are not aware of the amount of salt they eat or the health problems it can cause. Few people know that a simple switch to potassium-rich salt can help lower blood pressure and reduce the risk of stroke and heart disease.

Limited availability is another challenge. Many Australian retailers stock potassium-rich salt, but there is usually only one brand available, often on the bottom shelf or in a specialty food aisle.

Potassium-rich salts also cost more than regular salt, although they are still low cost compared to most other foods, and not as expensive as many of the fancy salts available now.

A 2021 review found that potassium-enriched salts were marketed in only 47 countries and most of them were high-income countries. Prices ranged from the same price as regular salt to nearly 15 times greater.

Although potassium-rich salt is generally more expensive, it has the potential to be very cost-effective for disease prevention.

Prevent damage

A recurring concern about the use of potassium-rich salt is the risk of high blood potassium levels (hyperkalemia) in about 2% of the population with serious kidney disease.

People with serious kidney disease are already advised to avoid regular salt and avoid foods high in potassium.

No harm from potassium-rich salt has been recorded in any trial conducted to date, but all studies were conducted in a clinical setting with specific directions for people with kidney disease.

Our current priority is to get people under management of high blood pressure to use potassium-enriched salt because healthcare providers can advise against its use in people at risk of hyperkalemia.

In some countries, potassium-rich salt is recommended for the entire community because the potential benefits are so great. A pilot study showed that nearly half a million strokes and heart attacks could be avoided each year in China if residents switched to potassium-rich salt.

What will happen next?

In 2022, the Minister of Health launched the National High Blood Pressure Task Force, which aims to improve blood pressure control rates from 32% to 70% by 2030 in Australia.

Potassium-rich salt can play a key role in achieving this. We are working with the task force to update the Australian guidelines for the management of hypertension, and promote the new guidelines for health professionals.

In parallel, we need potassium-rich salt to be accessible to everyone. We are working to engage stakeholders to increase the availability of these products nationwide.

The world has already changed its salt supply once: from regular salt to iodized salt. Iodization efforts began in the 1920s and took the best part of 100 years to achieve success. Adding iodine to salt is one of the most important public health achievements of the last century, preventing goiter (a condition in which the thyroid gland grows larger) and boosting educational outcomes for millions of the world’s poorest children, as iodine is essential for normal growth and brain development.

The next switch to iodized, potassium-enriched salt offers at least the same potential for global health gains. But we have to make it happen in a fraction of the time.

Xiaoyu Xu (Luna), lecturer in science, University of New South Wales Sydney; Alta Schott, professor of cardiovascular medicine at SHARP University of New South Wales SydneyBruce Neal, Executive Director of the George Australia Institute, George Institute for Global Health

This article is republished from The Conversation under a Creative Commons license. Read the original article.