Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis
Why the study?
Following the SSaSS trial, the consistency of findings and generalisability of potassium-enriched salt substitute benefits across varied outcomes, geographies, and populations remained to be clarified.
Does salt substitute reduce blood pressure and cardiovascular events in trial participants?
Population
31 949 participants across 21 trials
Comparison
Salt substitutes vs comparator
Design
Systematic review and meta-analysis of randomised controlled trials
Authors
Discussion
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Implication
Supports recommending salt substitutes in hypertension care; confirms BP and mortality benefits across diverse trial populations.
Key Points
- To assess the consistency and generalizability of the effects of potassium-enriched salt substitutes on blood pressure, cardiovascular outcomes, and mortality across diverse populations.
- Systematic review and meta-analysis of PubMed, Embase, and Cochrane Library through August 31, 2021, including parallel-group, stepped-wedge, and cluster randomized controlled trials (PROSPERO: CRD42020161077).
- Included 21 randomized trials encompassing 31,949 participants, with 19 trials reporting effects on blood pressure and 5 reporting clinical endpoints analyzed via meta-analyses and metaregressions.
- Salt substitutes reduced systolic blood pressure by -4.61 mm Hg (95% CI -6.07 to -3.14) and diastolic blood pressure by -1.61 mm Hg (95% CI -2.42 to -0.79), with each 10% lower sodium chloride proportion conferring additional SBP (-1.53 mm Hg, p=0.045) and DBP (-0.95 mm Hg, p=0.025) reductions.
- Salt substitutes significantly reduced total mortality (risk ratio [RR] 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0.81 to 0.94), and major cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94).
Structured PICO
Does salt substitute reduce blood pressure and cardiovascular events in trial participants?
P
Population
31,949 participants from 21 randomized controlled trials (parallel group, step-wedge or cluster)
I
Intervention
Salt substitute (potassium-enriched)
C
Comparator
Control (regular salt)
O
Outcome
Blood pressure (systolic and diastolic) and clinical outcomes (total mortality, cardiovascular mortality, cardiovascular events)hard clinical
Salt substitutes consistently lower blood pressure and reduce the risk of total mortality and cardiovascular events across diverse populations and geographies.
Cite This Study
Yin et al. (2022) studied this question.