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Grand Rounds

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

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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

METHODS:

  • 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

RESULTS:

  • 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)

CONCLUSION:

  • 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

Learn More – Primary Sources:

Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis

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