Enriched Potassium Salt should be included in recommendations for patients with hypertension. An international group of experts from the United States, Australia, Japan, South Africa and India, published an article in the Journal of the American Heart Association, calls for this in 2024 “Hypertension“. The appeal is addressed to consumers, doctors and governments around the world. The key to reducing risk Hypertension, strokes and heart disease lies in the balance of sodium and potassium, the scientists write. Regular salt leads to excess sodium and potassium deficiency, which poses a real health threat. Potassium-fortified dietary salt helps reduce the amount of sodium consumed while increasing the intake of deficient potassium.
Presentation of the main ideas
Excess dietary sodium intake and Potassium deficiency are well known as risk factors for hypertension. Despite some successful initiatives, efforts to control hypertension by improving nutrition have largely failed due to the difficulty of implementing the necessary changes. Recent recent evidence from randomized controlled trials suggests that reduced-sodium salts fortified with potassium are an effective option for improving intake levels and lower blood pressure, as well as the incidence of cardiovascular disease and mortality. However, substitute salts are recommended ad hoc and are rarely used. We tried to determine the extent to which the inclusion of evidence on the likely benefits and harms of potassium-fortified substitute salts was implemented in clinical practice by systematically analysing recommendations for the management of hypertension or chronic kidney disease. We found incomplete and inconsistent recommendations for the use of potassium substitute salts in the 32 hypertension guidelines and the 14 kidney disease guidelines we reviewed. Discussion among the authors has identified the possibility of updating clinical guidelines to provide consistent advice on the use of potassium-fortified salts for hypertension control. Draft texts for starting debates and building consensus have been formulated: A categorical recommendation for patients with hypertension is potassium-enriched salts containing ≈75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, except for those who suffer from severe kidney disease, are taking a potassium preparation, are using a potassium-sparing diuretic, or have other contraindications. We strongly encourage clinical guideline authorities to review their recommendations for the use of potassium substitute salts as soon as possible.
RECOMMENDED TEXT FOR INCLUSION IN CLINICAL GUIDELINES
Adopting harmonized standardized language to describe recommendations for the use of potassium-fortified salt will give consumers, physicians and governments around the world confidence in best practices. To this end, we have developed a boilerplate text that can serve as a basis for discussion on clinical facility updates around the world. This text will be sent to the guideline development groups for comment and wide clinical application.
RECOMMENDED STANDARD FORMULATIONS FOR GUIDELINES FOR THE USE OF POTASSIUM-FORTIFIED SALT IN CLINICAL SETTINGS
Strong recommendation for patients with hypertension
Potassium-enriched salt with ≈75% sodium chloride and 25% potassium chloride should be recommended to all patients with hypertension, unless they have advanced kidney disease, potassium supplements, potassium-sparing diuretics, or other contraindications.
Conditional recommendation for the public
If you have to add salt to your food, potassium-fortified salt with the composition
≈75% sodium chloride and 25% potassium chloride can be recommended for use in the general public in settings where there is a low probability that people with advanced kidney disease (stages 4 and 5) will not be diagnosed by the health care system, and contraindications may be printed on the product packaging.
The strong recommendation for use in patients with hypertension is based on the assumption that clinical contact inherent in the treatment of hypertension will control the risk of hyperkalemia.
It is important to increase production capacity and meet the growing market demand for salt substitutes. Key stakeholders, such as the American Heart Association and the American Society of Nephrology, as well as global organizations, are urged to collaborate with manufacturers and provide guidance on the use of potassium-fortified salt substitutes as an alternative to traditional salt (including in processed, packaged, and prepared foods) that promote heart health.
Replacing traditional salt with potassium-fortified salt substitutes in the household may result in a cumulative protective effect across the lifespan, likely leading to improved blood pressure control from childhood and prevention of cardiovascular disease in adulthood.
CONCLUSIONS
There is a large body of evidence to support replacing regular salt with potassium fortified salt in patients with hypertension. There is also evidence to support a switch to potassium-fortified salt for the general population, where the dangers of misuse can be controlled. Current clinical guidelines offer incomplete and inconsistent recommendations for the use of potassium-fortified salt substitutes, as well as reducing dietary sodium intake and increasing dietary potassium intake. We encourage all relevant clinical guidelines to discuss the value of potassium-fortified salt as a routine adjunct to drug therapy and to update their recommendations accordingly.
Evidence suggests that the much wider use of potassium-fortified salt, consisting of ≈75% sodium chloride and 25% potassium chloride may provide significant benefit to patients with hypertension. As part of updating clinical guidelines, guideline setting bodies should provide consistent recommendations on the use of potassium-fortified salt substitutes and actively promote these recommendations to their members.
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