Pass the potassium

Researchers push for guidelines recommending low-sodium table salt to reduce soaring rates of hypertension.

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Table salt containing 25% potassium should be recommended for all patients except those with advanced kidney disease, researchers say. 

Widespread consumption of potassium-enriched, sodium-reduced table salt would help reduce soaring rates of hypertension and cardiovascular disease, say the international researchers led by The George Institute for Global Health in Sydney.  

But potassium-enriched salt was rarely used, and guidelines were inconsistent, they added, urging clinical guidelines bodies to review their recommendations “at the earliest opportunity”. 

“Reducing dietary sodium and increasing dietary potassium remain public health priorities with huge potential for disease prevention,” they said in Hypertension.  

Lead author Professor Alta Schutte said potassium-enriched salt would not only have significant benefits for patients with hypertension but also for the general population – with some exceptions. 

“It can be safely recommended to all patients – in particular those with hypertension – but not for patients with advanced kidney diseases, who are using a potassium supplement, are using a potassium-sparing diuretic or have another contraindication,” Professor Schutte, from the University of NSW and The George Institute, told TMR. 

“It has been practically impossible to lower salt intake in the population for decades – although it has been a major program of the WHO.  

“Potassium-enriched salt provides a solution to simply switch current use of table salt to potassium-enriched salt.”  

Professor Schutte said several research papers in the past few years had consistently supported the benefits of potassium-enriched salt.  

“The evidence is overwhelming, but we need to start acting,” she said. 

Professor Schutte said some GPs had questioned whether patients taking ACE inhibitors or angiotensin receptor blockers should avoid potassium-enriched salt.  

“We do not feel that this should be a reason to avoid using potassium-enriched salt.” 

That was because the effects of ACE inhibitors and ARBs on blood potassium were typically small in patients with preserved kidney function, Professor Schutte said. 

Also, patients using ACE or ARB were not routinely recommended to eat a low potassium diet since the risk of hyperkalaemia was low in the absence of advanced kidney disease, she said. 

“In the absence of advanced kidney disease, it is only medicines that substantially raise blood potassium that should serve routinely as a contraindication to use of potassium-enriched salt – like potassium sparing diuretics and potassium supplements,” she said. 

Professor Schutte said 2021 research in the NEJM led by The George Institute’s Professor Bruce Neal showed no increase in hyperkalaemia risk overall among 5000 patients who were taking ACE inhibitors or ARBs and who used potassium-enriched salt.  

“In the Australian setting it should be remembered that we consume about 75% of our salt from processed foods,” she said.  

“When using a potassium-enriched salt, it is only for the remaining discretionary salt use which is 25%.” 

Professor Schutte said it was still recommended that people reduce their overall salt intake, “but if a person needs to add salt to their foods, a potassium-enriched salt switch would be ideal”, she said. 

The researchers said the cumulative effects of the salt replacement applied across the entire life course and could lead to better blood pressure control from childhood and the prevention of cardiovascular disease into adulthood. 

Hypertension 2024, online 29 January