Potassium-Enriched Salt Substitutes: A Review of Recommendations in Clinical Management Guidelines

Author:

Xu Xiaoyue12ORCID,Zeng Ling1ORCID,Jha Vivekanand345,Cobb Laura K.6,Shibuya Kenji7ORCID,Appel Lawrence J.8ORCID,Neal Bruce24ORCID,Schutte Aletta E.12910ORCID

Affiliation:

1. School of Population Health (X.X., L.Z., A.E.S.), University of New South Wales Sydney, Kensington, Australia.

2. The George Institute for Global Health (X.X., B.N., A.E.S.), University of New South Wales Sydney, Kensington, Australia.

3. The George Institute for Global Health, University of New South Wales, New Delhi, India (V.J.).

4. School of Public Health, Imperial College London, United Kingdom (V.J., B.N.).

5. Prasanna School of Public Health, Manipal Academy of Higher Education, India (V.J.).

6. Resolve to Save Lives, New York, NY (L.K.C.).

7. Tokyo Foundation for Policy Research, Japan (K.S.).

8. Department of Epidemiology, Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD (L.J.A.).

9. Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.).

10. Department of Paediatrics, Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa (A.E.S).

Abstract

Excess dietary sodium intake and insufficient dietary potassium intake are both well-established risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving dietary intake have largely failed because the changes required are mostly too hard to implement. Consistent recent data from randomized controlled trials show that potassium-enriched, sodium-reduced salt substitutes are an effective option for improving consumption levels and reducing blood pressure and the rates of cardiovascular events and deaths. Yet, salt substitutes are inconsistently recommended and rarely used. We sought to define the extent to which evidence about the likely benefits and harms of potassium-enriched salt substitutes has been incorporated into clinical management by systematically searching guidelines for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations about the use of potassium-enriched salt substitutes in the 32 hypertension and 14 kidney guidelines that we reviewed. Discussion among the authors identified the possibility of updating clinical guidelines to provide consistent advice about the use of potassium-enriched salt for hypertension control. Draft wording was chosen to commence debate and progress consensus building: strong recommendation for patients with hypertension—potassium-enriched salt with a composition of 75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication. We strongly encourage clinical guideline bodies to review their recommendations about the use of potassium-enriched salt substitutes at the earliest opportunity.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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