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Randomized Controlled Trial
. 2020 Mar;26(3):374-378.
doi: 10.1038/s41591-020-0754-2. Epub 2020 Feb 17.

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

Antonio Bernabe-Ortiz  1 , Víctor G Sal Y Rosas  2 , Vilarmina Ponce-Lucero  1 , María K Cárdenas  1 , Rodrigo M Carrillo-Larco  1   3 , Francisco Diez-Canseco  1 , M Amalia Pesantes  1 , Katherine A Sacksteder  4 , Robert H Gilman  4 , J Jaime Miranda  5   6
Affiliations
Randomized Controlled Trial

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

Antonio Bernabe-Ortiz et al. Nat Med. 2020 Mar.

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.

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Conflict of interest statement

Competing Interests

None declared.

Figures

Figure 1
Figure 1. Flowchart diagram of participants in the stepped wedge trial
LTFU = Lost to follow-up. Randomization of villages occurred after baseline assessment.
Figure 2
Figure 2. Trends in mean SBP (A) and DBP (B) and their respective 95% confidence intervals by intervention and control group
Time periods are 5-month analysis periods occurring before the initiation of the intervention in each wave (n = 2072).
Figure 3
Figure 3. Structure and time framework of the stepped wedge cluster randomized trial
* Assessment of participants included a short questionnaire and weight and blood pressure measurements.
See this image and copyright information in PMC

Comment in

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