Wednesday, February 21, 2024
Wednesday, February 21, 2024
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Salt substitute reduces incidence of hypertension in older adults


Replacing regular salt with a salt substitute in older adults with normal blood pressure (BP) reduced the incidence of hypertension without increasing the rate of hypotension, according to a study published today in Journal of the American College of Cardiology.

DECIDE-Salt was a multicenter, cluster-randomized study of older adults in elderly care facilities in China with normal blood pressure. China has a rapidly growing population of adults with hypertension, with 27.5% of adults living with the condition, the study authors wrote.

The dangers of salt

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The primary outcome of the study was incident hypertension, which was defined as an individual having a blood pressure greater than 140/90 mm Hg after multiple follow-ups, initiating antihypertensive medications, or having a major cardiovascular adverse event (e.g. , coronary heart disease, stroke). , the researchers wrote. Additionally, they monitored for any episodes of hypotension during follow-up.

In this study, the salt substitute was composed of 62.5% sodium chloride, 25% potassium chloride, and 12.5% ​​flavoring ingredient. The overall study population was 611 participants (salt substitute group, 311; normal salt group, 298) with a normal baseline BP; Their mean age was 71.4 years and their mean BP was 121.9/74.4 mm Hg.

Over 2 years and 4 follow-up visits, participants’ BP values ​​were measured. The researchers found that the incidence of hypertension among participants in the salt substitute cohort was 11.7 per 100 person-years, while it was 24.3 per 100 person-years for participants in the salt cohort. normal.

Participants on the salt substitute were 40% less likely to develop hypertension (adjusted HR, 0.60; 95% CI, 0.39-0.92; P = .020) compared to those who consume regular salt, according to the study results.

Additionally, participants experienced 100 episodes of hypotension over 2 years of follow-up, although no clinically diagnosed hypotension was reported. Interestingly, the incidence of hypotensive episodes did not differ significantly between participants who used the salt substitute and those who used regular salt: 9.0 versus 9.7 per 100 person-years, respectively (adjusted rate ratio, 1 .10, 95% CI, 0.59-2.07; P = .760).

The overall mean change in systolic BP (SBP) and diastolic BP (DBP) was also examined, with increases from baseline of 7.0 and 2.1 mm Hg, respectively (both P < 0.001), in those in the usual salt cohort; no change was observed between n participants who used the salt substitute (both P > .59), the researchers found. Participants who used the salt substitute ALSO had lower mean SBP (mean difference: –8.0; 95% CI –12.4 to –3.7; P < 0.001) and borderline lower mean DBP (mean difference: –2.0; 95% CI –4.1 to 0.1; P = .056), indicated the results of the study.

The researchers noted that the lack of an increase in hypotensive episodes made replacing salt with a salt substitute safer than using antihypertensive medications, which have been linked to an increased risk of hypotension. These results indicate a benefit in using salt substitute for older adults who have normal blood pressure, and that this adjustment may be a viable population-wide strategy to prevent cardiovascular disease and control hypertension, the researchers wrote.

The researchers noted that no other research on salt substitutes has reported an association between a potassium-enriched salt substitute and the risk of hypotension. That this study was the first to report the possible association is important because of the risk that hypotension poses to older adults, including the risk of fall-related injuries.

The researchers reported several strengths of the study. The study results were derived from a large, randomized, parallel-controlled trial, and DECIDE-Salt was conducted exclusively among older adults living in a controlled environment, which helped ensure appropriate implementation of the primary outcome and resulted in a large reduction in blood pressure, the researchers said. wrote.

However, some limitations were noted. The study was a post hoc analysis, with results that were not prespecified. Additionally, there was a lack of follow-up visits at 6 and 18 months, which meant that a significant proportion of BP measurements were missing from the study. Finally, since the study was conducted in China, where salt consumption is high, generalizability to other countries should be considered.

“The results suggest that salt substitution produces only benefits but no harm, providing additional evidence supporting the use of potassium-enriched salt substitutes as a population-based strategy for sodium reduction in the prevention and control of hypertension and cardiovascular diseases in China,” the study authors concluded.

Reference

Zhang X, Yuan Y, Li C, et al. Effect of a salt substitute on the incidence of hypertension and hypotension among normotensive adults. J. Am Coll Cardiol. Published online February 12, 2024. doi:10.1016/j.jacc.2023.12.013



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