Evidence Summary

What is an Evidence Summary?

Key messages from scientific research that's ready to be acted on

Got It, Hide this
  • Rating:

Low-sodium salt substitutes reduce blood pressure but do not affect risk for other cardiovascular diseases

Hernandez AV, Emonds EE, Chen BA, et al. Effect of low-sodium salt substitutes on blood pressure, detected hypertension, stroke and mortality. Heart. 2019;105:953-60.

Review question

In patients with or without high blood pressure (hypertension), does using a low-sodium salt substitute reduce blood pressure, new or existing hypertension, or death compared with regular salt?


Lowering salt intake can reduce blood pressure and the risk for cardiovascular diseases such as stroke. There are low-sodium products available that use other minerals like potassium. This review looks at whether using a salt substitute can improve blood pressure and cardiovascular outcomes.

How the review was done

The researchers did a systematic review of studies available up to May 2018. They found 21 randomized controlled trials (RCTs) with 7,403 people (between 14% to 68% men per trial). The average age of the people studied was 59 years.

The key features of the RCTs were:

  • 15 RCTs included only people with high blood pressure, 2 RCTs included only people without high blood pressure, and 4 RCTs included both;
  • 14 different low-sodium substitutes were used;
  • trials lasted for 1 week to 44 months.

What the researchers found

The evidence for the effect of low-sodium salt substitutes was very low to moderate, which means that new studies are likely to find different results.

Compared with regular salt use, low-sodium salt substitutes:

  • reduced systolic and diastolic blood pressure in people with or without hypertension;
  • did not affect risk for new or existing hypertension;
  • did not affect risk for death.


In people with or without hypertension, using low-sodium salt substitutes reduced blood pressure but did not affect new or existing hypertension or death.

Low-sodium salt substitutes vs regular salt in people with or without hypertension


Number of trials and people

Absolute effect of low-sodium substitutes

Quality of the evidence*

Systolic blood pressure

16 trials (1993 people)

Systolic blood pressure was about 7.8 mm Hg lower for people using salt substitutes.


Diastolic blood pressure

16 trials (199 people)

Diastolic blood pressure was about 4.0 mm Hg lower for people using salt substitutes.


New or existing hypertension

4 (2928)

No difference in effect

Very low


2 (2159)

No difference in effect


*Evidence quality was rated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).


The lower number in a blood pressure reading. It is the pressure when the heart rests between beats.
Randomized controlled trials
Studies where people are assigned to one of the treatments purely by chance.
Systematic review
A comprehensive evaluation of the available research evidence on a particular topic.
The higher number in a blood pressure reading. It is the pressure in the arteries when the heart beats.
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

Related Web Resources

  • Patient education: Quitting smoking (Beyond the Basics)

    UpToDate - patient information
    There are many strategies available to help you quit smoking. Start by picking a quit date. Consider speaking with a health care provider for advice, seeking in-person or telephone support, making behavioural changes, and using different medications such as varenicline, bupropion, or nicotine replacement therapy.
  • Worried about dementia? Here are 5 ways to cut your risk

    Dementia affects millions of people around the world, and there is no current treatment. There are a few ways to lower your risk. Eat a well-balanced diet, exercise, stay social, and limit alcohol and smoking.
  • Heartburn and GERD

    Informed Health Online
    Regular acid reflux may mean you have gastro-esophageal reflux disease, also known as GERD. Treatment for GERD includes lifestyle changes, medication or surgery.
DISCLAIMER These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (

Register for free access to all Professional content