Salt Substitutes and Potassium Chloride: Benefits for Blood Pressure and Who Should Avoid Them
What trials found when potassium-enriched salt replaced regular salt for blood pressure and stroke, and who should avoid these products, including people with kidney disease or some blood pressure medicines.
Content last updated . This page has not been medically reviewed.
What a salt substitute is
A Cochrane review describes low-sodium salt substitutes as products where some sodium chloride is displaced, mostly by potassium. [2] In the 26 trials it reviewed, the share of sodium chloride replaced ranged from about 3% to 77%. [2] So "salt substitute" and "low-sodium salt" are not one standard recipe, and the label matters. The US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) notes that potassium chloride is also sometimes used in place of salt in packaged foods, so it can appear on ingredient lists. [3]What the trials found
Practical points from the sources
- In most of the trials (22 of 26), people used the substitute at their own discretion in place of regular salt, so the results describe household use, not packaged foods. [2]
- NIDDK advises people whose potassium is high to use spices and herbs instead of salt substitutes. [3]
- Cutting sodium in general also lowers blood pressure: a meta-analysis of 133 trials found each 50 mmol drop in 24-hour sodium excretion lowered systolic pressure by 1.10 mm Hg. [7] See sodium intake guidelines and where salt hides.
- The same kidney and medicine cautions apply to potassium supplements. See Potassium and Hyperkalemia.
- Medicine interactions are covered at Medication Interactions. A pharmacist can check your own list.
Related
Sodium and chloride, Potassium intake levels and the DASH diet, Minerals, supplements and kidney disease.Frequently asked questions
Do salt substitutes lower blood pressure?
In a Cochrane review of trials, they lowered systolic pressure by about 4.76 mm Hg on average compared with regular salt, with moderate certainty. [2]
Do they reduce strokes?
In the SSaSS trial of older adults or people with prior stroke in rural China, stroke was less frequent (rate ratio 0.86). [4] A later review rated the wider evidence as low certainty and dominated by this one trial. [5]
Who should avoid potassium-based salt substitutes?
People with kidney disease or on ACE inhibitors, angiotensin receptor blockers or spironolactone-type medicines are at higher risk of high potassium, so they should ask a clinician first. [1]
Are they safe in pregnancy or for children?
No pregnancy studies were found, and the evidence in children is very uncertain, so ask a clinician. [2]
Can I use a salt substitute if my potassium is already high?
NIDDK advises people with high potassium to use spices and herbs instead of salt substitutes. [3]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
How to read the evidence labels
Labels used on this page: evidence in adults with the stated risk profile, low or very low certainty (the reviewers' own grading), and Proper evidence not found.
| Question | What the source found | Strength |
|---|---|---|
| Stroke, heart events and death (SSaSS trial, rural China) | About 21,000 people with prior stroke, or aged 60+ with high blood pressure, used 75% sodium chloride / 25% potassium chloride or regular salt for about 4.7 years. Stroke rate ratio 0.86; major cardiovascular events 0.87; death from any cause 0.88. [4] | Large trial, one population |
| Blood pressure, all trials | Compared with regular salt, systolic pressure was lower by 4.76 mm Hg and diastolic by 2.43 mm Hg on average (20 and 19 trials). [2] | Moderate certainty (Cochrane, 2022) |
| Long-term outcomes, trials of 6 months or more | Salt substitutes may lower all-cause and cardiovascular death, but the evidence base is dominated by one large trial. [5] | Low certainty for death; very low for heart events |
| Generalizing to other countries | Most trials were in China or Taiwan, so generalizability to other populations is very limited. [5] | Limitation |
| Pregnancy | No studies in pregnant women were identified. [2] | Proper evidence not found |
| Children | The evidence is very uncertain for blood pressure in children. [2] | Very low certainty |
The World Health Organization says that if people choose to use table salt, it suggests lower-sodium salt substitutes that contain potassium. [6] WHO's fact sheet does not describe who should avoid them, so we do not state a WHO exclusion list here.
Who should check first
Safety findings and their limits
References
- MedlinePlus (US National Library of Medicine). Review date 10/1/2025. MedlinePlus Medical Encyclopedia, High potassium level. Read 2026-10-23.
- Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. Cochrane Database of Systematic Reviews 2022. PubMed 35944931. Read 2026-10-23.
- National Institute of Diabetes and Digestive and Kidney Diseases (US NIH). Last reviewed January 2025. NIDDK, Healthy Eating for Adults with Chronic Kidney Disease. Read 2026-10-23.
- Effect of Salt Substitution on Cardiovascular Events and Death (SSaSS). New England Journal of Medicine 2021. PubMed 34459569. Read 2026-10-23.
- Long-Term Effect of Salt Substitution for Cardiovascular Outcomes: A Systematic Review and Meta-analysis. Annals of Internal Medicine 2024. PubMed 38588546. Read 2026-10-23.
- World Health Organization. Page dated 11 May 2026. WHO, Sodium reduction (fact sheet). Read 2026-10-23.
- Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials. BMJ 2020. PubMed 32094151. Read 2026-10-23.