Grand Rounds

Meta-Analysis: Do Salt Substitutes Improve Blood Pressure and Clinical Outcomes?

BACKGROUND AND PURPOSE:

Yin et al. (Heart, 2022) performed a systematic review to summarize the effects of salt substitute on blood pressure and clinical outcomes for all available trials and assess the constancy of the findings across diverse populations

Systematic review and meta-analysis
Inclusion criteria
- RCTs
- Studies that report on the effects of salt substitutes on blood pressure or clinical outcomes
Study design
- Meta-analyses and metaregression were used to define the consistency of findings across trials, geographies and patient subgroups
Primary outcome
- Effects of salt substitutes on blood pressure and clinical outcomes

21 trials | 31,949 participants
Salt substitutes were associated with an overall reduction of
- Systolic BP: -4.61 mm Hg (95% CI, −6.07 to −3.14)
- Diastolic BP: −1.61 mm Hg (95% CI, −2.42 to −0.79)
Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by
- Age
- Sex
- History of hypertension
- BMI
- Baseline blood pressure
- Baseline 24-hour urinary sodium
- Baseline 24-hour urinary potassium
Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a reduction in
- Systolic BP: −1.53 mm Hg (95% CI, −3.02 to −0.03); P=0.045
- Diastolic BP: −0.95 mm Hg (95% CI, −1.78 to −0.12); P=0.025
There were clear protective effects of salt substitutes on
- Total mortality: RR 0.89 (95% CI, 0.85 to 0.94)
- Cardiovascular mortality: RR 0.87 (95% CI, 0.81 to 0.94)
- Cardiovascular events: RR 0.89 (95% CI, 0.85 to 0.94)

Salt substitutes appear to have a beneficial effect on BP across populations, geographies, and clinical subgroups
The authors state

Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide

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