Effect of salt substitution on community-wide blood pressure and hypertension incidence

Antonio Bernabe-Ortiz, Víctor G. Sal y Rosas, Vilarmina Ponce-Lucero, María K. Cárdenas, Rodrigo M. Carrillo-Larco, Francisco Diez-Canseco, M. Amalia Pesantes, Katherine A. Sacksteder, Robert H. Gilman, J. Jaime Miranda

Research output: Contribution to journalArticle

Abstract

Replacement of regular salt with potassium-enriched substitutes reduces blood pressure in controlled situations, mainly among people with hypertension. We report on a population-wide implementation of this strategy in a stepped-wedge cluster randomized trial (NCT01960972). The regular salt in enrolled households was retrieved and replaced, free of charge, with a combination of 75% NaCl and 25% KCl. A total of 2,376 participants were enrolled in 6 villages in Tumbes, Peru. The fully adjusted intention-to-treat analysis showed an average reduction of 1.29 mm Hg (95% confidence interval (95% CI) (−2.17, −0.41)) in systolic and 0.76 mm Hg (95% CI (−1.39, −0.13)) in diastolic blood pressure. Among participants without hypertension at baseline, in the time- and cluster-adjusted model, the use of the salt substitute was associated with a 51% (95% CI (29%, 66%)) reduced risk of developing hypertension compared with the control group. In 24-h urine samples, there was no evidence of differences in sodium levels (mean difference 0.01; 95% CI (0.25, −0.23)), but potassium levels were higher at the end of the study than at baseline (mean difference 0.63; 95% CI (0.78, 0.47)). Our results support a case for implementing a pragmatic, population-wide, salt-substitution strategy for reducing blood pressure and hypertension incidence.

Original languageEnglish (US)
Pages (from-to)374-378
Number of pages5
JournalNature medicine
Volume26
Issue number3
DOIs
StatePublished - Mar 1 2020

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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    Bernabe-Ortiz, A., Sal y Rosas, V. G., Ponce-Lucero, V., Cárdenas, M. K., Carrillo-Larco, R. M., Diez-Canseco, F., Pesantes, M. A., Sacksteder, K. A., Gilman, R. H., & Miranda, J. J. (2020). Effect of salt substitution on community-wide blood pressure and hypertension incidence. Nature medicine, 26(3), 374-378. https://doi.org/10.1038/s41591-020-0754-2