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Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: a randomized, double-blind, controlled trial.
Am J Clin Nutr. 2021 07 01; 114(1):185-193.AJ

Abstract

BACKGROUND

High salt intake is a major modifiable risk factor of hypertension which is prevalent in India. It is not yet clear if salt substitutes reduce blood pressure (BP) among Indian hypertensive patients.

OBJECTIVES

Examine the acceptability, usage, and BP effects of a reduced-sodium and added-potassium salt substitute among hypertensive patients.

METHODS

We enrolled 502 participants with hypertension (aged 61.6 ± 12.0 y, 58.8% women) from 7 villages in rural India. Participants were randomly assigned to receive either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride blend), and advised to replace all home salt use. The primary outcome was the change in systolic BP (SBP) from baseline to 3 mo comparing the salt substitute and regular salt groups. Secondary outcomes included the change in diastolic BP (DBP), 24-h urinary biomarkers, and self-reported use and satisfaction with the study salt provided.

RESULTS

A total of 494 (98%) participants completed 1 mo and 476 (95%) participants completed the 3-mo follow-up. At 3 mo, the salt substitute intervention significantly decreased the average SBP by 4.6 mmHg (95% CI: 3.0, 6.2, P < 0.001) and DBP by 1.1 mmHg (95% CI: 0.2, 2.1 mmHg, P = 0.02). There was a significant increase in 24-h urinary potassium excretion in the salt substitute group by 0.24 g/d (95% CI: 0.12, 0.35 g/d, P < 0.001) and a decrease in the urinary sodium to potassium ratio by 0.71 (95% CI: 0.55, 0.87, P < 0.0001) compared with the control group. Participants reported that they used the study salt nearly every day of the week (mean ± SD, 6.3 ± 1.8 d) and rated the taste of the study salts similarly.

CONCLUSION

The reduced-sodium added-potassium salt led to a substantial reduction in SBP in hypertensive patients, supporting salt substitution as an effective, low-cost intervention for BP lowering in rural India. This trial was registered at clinicaltrials.gov as NCT03909659.

Authors+Show Affiliations

The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. Department of Cardiology, Peking University Third Hospital, Beijing, China.The George Institute for Global Health India, Punjagutta, Hyderabad, India.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. The George Institute for Global Health at Peking University Health Science Centre, Beijing, China.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. Sydney Medical School, University of Sydney, Sydney, Australia.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. Northwestern University Feinberg School of Medicine, Chicago, IL, USA.The George Institute for Global Health India, Punjagutta, Hyderabad, India.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia. Imperial College London, London, United Kingdom.The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33782684

Citation

Yu, Jie, et al. "Effects of a Reduced-sodium Added-potassium Salt Substitute On Blood Pressure in Rural Indian Hypertensive Patients: a Randomized, Double-blind, Controlled Trial." The American Journal of Clinical Nutrition, vol. 114, no. 1, 2021, pp. 185-193.
Yu J, Thout SR, Li Q, et al. Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: a randomized, double-blind, controlled trial. Am J Clin Nutr. 2021;114(1):185-193.
Yu, J., Thout, S. R., Li, Q., Tian, M., Marklund, M., Arnott, C., Huffman, M. D., Praveen, D., Johnson, C., Huang, L., Pettigrew, S., Neal, B., & Wu, J. H. Y. (2021). Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: a randomized, double-blind, controlled trial. The American Journal of Clinical Nutrition, 114(1), 185-193. https://doi.org/10.1093/ajcn/nqab054
Yu J, et al. Effects of a Reduced-sodium Added-potassium Salt Substitute On Blood Pressure in Rural Indian Hypertensive Patients: a Randomized, Double-blind, Controlled Trial. Am J Clin Nutr. 2021 07 1;114(1):185-193. PubMed PMID: 33782684.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of a reduced-sodium added-potassium salt substitute on blood pressure in rural Indian hypertensive patients: a randomized, double-blind, controlled trial. AU - Yu,Jie, AU - Thout,Sudhir Raj, AU - Li,Qiang, AU - Tian,Maoyi, AU - Marklund,Matti, AU - Arnott,Clare, AU - Huffman,Mark D, AU - Praveen,Devarsetty, AU - Johnson,Claire, AU - Huang,Liping, AU - Pettigrew,Simone, AU - Neal,Bruce, AU - Wu,Jason H Y, PY - 2020/11/09/received PY - 2021/02/10/accepted PY - 2021/3/31/pubmed PY - 2021/9/8/medline PY - 2021/3/30/entrez KW - India KW - blood pressure KW - potassium KW - salt substitute KW - sodium SP - 185 EP - 193 JF - The American journal of clinical nutrition JO - Am J Clin Nutr VL - 114 IS - 1 N2 - BACKGROUND: High salt intake is a major modifiable risk factor of hypertension which is prevalent in India. It is not yet clear if salt substitutes reduce blood pressure (BP) among Indian hypertensive patients. OBJECTIVES: Examine the acceptability, usage, and BP effects of a reduced-sodium and added-potassium salt substitute among hypertensive patients. METHODS: We enrolled 502 participants with hypertension (aged 61.6 ± 12.0 y, 58.8% women) from 7 villages in rural India. Participants were randomly assigned to receive either regular salt (100% sodium chloride) or the salt substitute (70% sodium chloride/30% potassium chloride blend), and advised to replace all home salt use. The primary outcome was the change in systolic BP (SBP) from baseline to 3 mo comparing the salt substitute and regular salt groups. Secondary outcomes included the change in diastolic BP (DBP), 24-h urinary biomarkers, and self-reported use and satisfaction with the study salt provided. RESULTS: A total of 494 (98%) participants completed 1 mo and 476 (95%) participants completed the 3-mo follow-up. At 3 mo, the salt substitute intervention significantly decreased the average SBP by 4.6 mmHg (95% CI: 3.0, 6.2, P < 0.001) and DBP by 1.1 mmHg (95% CI: 0.2, 2.1 mmHg, P = 0.02). There was a significant increase in 24-h urinary potassium excretion in the salt substitute group by 0.24 g/d (95% CI: 0.12, 0.35 g/d, P < 0.001) and a decrease in the urinary sodium to potassium ratio by 0.71 (95% CI: 0.55, 0.87, P < 0.0001) compared with the control group. Participants reported that they used the study salt nearly every day of the week (mean ± SD, 6.3 ± 1.8 d) and rated the taste of the study salts similarly. CONCLUSION: The reduced-sodium added-potassium salt led to a substantial reduction in SBP in hypertensive patients, supporting salt substitution as an effective, low-cost intervention for BP lowering in rural India. This trial was registered at clinicaltrials.gov as NCT03909659. SN - 1938-3207 UR - https://www.unboundmedicine.com/medline/citation/33782684/Effects_of_a_reduced_sodium_added_potassium_salt_substitute_on_blood_pressure_in_rural_Indian_hypertensive_patients:_a_randomized_double_blind_controlled_trial_ L2 - https://academic.oup.com/ajcn/article-lookup/doi/10.1093/ajcn/nqab054 DB - PRIME DP - Unbound Medicine ER -