Intervention Maps · Hypertension · Salt substitutes
Potassium-enriched salt substitutes
This page is about a defined salt product: about 75% sodium chloride and 25% potassium chloride. It is not a page about cutting salt in general, and it is not advice to eat more bananas.
See also: Cutting back on sodium.
Bottom line
A potassium-enriched salt substitute (about 75% sodium chloride / 25% potassium chloride) reduced stroke, major cardiovascular events, and death in the major cluster trial that studied it, in a population that excluded known serious kidney disease, potassium-sparing diuretics, and potassium supplements. That is not the same decision as cutting sodium alone, and it is not advice to eat more potassium-rich foods as if they inherited those event results.
What it is
A potassium-enriched salt substitute replaces part of the sodium chloride in table salt with potassium chloride. The product studied for hard outcomes was about three-quarters ordinary salt and one-quarter potassium salt. That product identity matters.
What taking part usually involves
In the landmark trial, villages switched the salt used in cooking and food preparation to the substitute. In ordinary care, any switch still needs a clinician conversation first, especially if you have kidney disease, take medicines that raise potassium, or take potassium supplements. This page does not tell you to self-switch.
What it is commonly confused with
“It's just another way of saying cut salt.” “Eat more potassium-rich foods and you get the same event benefit.” “If medicines prevent events, this is a weaker version of medicines.” “Anyone can use it safely.”
What the evidence shows
The Salt Substitute and Stroke Study (SSaSS) followed about 21,000 adults in rural China clusters for a mean of about 4.7 years. Using the 75%/25% salt substitute reduced stroke, major cardiovascular events, and death compared with regular salt (stroke relative risk about 0.86; major events about 0.87; death about 0.88). Hyperkalemia was not significantly increased in that trial population.
Those people were selected carefully. The trial excluded known serious kidney disease, potassium-sparing diuretics, and potassium supplements. Those exclusions travel with the claim.
Guidelines and lifestyle reviews may mention salt substitution or potassium in blood-pressure context. That is not the same as the hard-outcome product finding above, and it is not the same decision as sodium-reduction advice alone.
Who was studied, expectations, and limits
Population and context studied: adults in rural China clusters at elevated stroke risk, cooking and eating with the defined salt substitute, after excluding known serious kidney disease and certain potassium-raising medicines or supplements.
That is the research setting. It does not decide whether the product is appropriate for you.
Realistic expectation: in the settings studied, this product reduced serious cardiovascular events. Limits: not generic “cut salt” advice; not food-potassium slogans; kidney and high-potassium risk need clinician judgment; not a weaker grade of blood-pressure medicine, and not a replacement for indicated medicines when those are needed.
Evidence consulted Open sources
Key sources used to prepare this answer. This is not a citation for every sentence.
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