Reducing salt consumption is one of the main recommendations for the prevention and management of hypertension.
Less widespread, but very important, is the advice to
increase potassium intake
, which helps lower blood pressure.
The bad news is that, at the population level, neither of the two guidelines is met: in Argentina
more than twice as much sodium
is consumed (mainly through table salt and "hidden salt" in ultra-processed products) and barely any more than
half the recommended potassium intake
.
This imbalance (a lot of the bad, little of the good) is related to a higher risk of heart attack, stroke and premature death.
The good news is that scientific evidence has shown that making a small change can have a significant impact: the use of salts in which some of the sodium chloride (common table salt) is replaced by potassium chloride addresses both. problems at the same time.
Call to update recommendations
An international group of experts published an article in the American Heart Association (AHA) journal Hypertension calling for recommendations on potassium-fortified salt to be included in hypertension treatment guidelines. arterial hypertension (HTN).
"Given the large amount of evidence available, we believe it is time to include salt substitutes in treatment guidelines to help address rising rates of uncontrolled high blood pressure worldwide and
reduce preventable deaths
," the researchers stated. authors.
This is a group of researchers from the United States, Australia, Japan, South Africa and India who, after reviewing 32 different guidelines for the treatment of hypertension published in the last decade, concluded that, with some exceptions, "the current clinical guidelines offer recommendations
incomplete and inconsistent information
on the use of these salt substitutes.
They ask to incorporate the recommendation to use salt substitutes.
Photo Shutterstock.
They estimated that 20% of deaths linked to high blood pressure are related to excessive salt consumption.
As a result, they
"strongly"
recommended that bodies that develop clinical guidelines review their recommendations "as soon as possible" to include the use of potassium-enriched salt substitutes.
Discussion among the authors identified the possibility of updating clinical guidelines to provide "consistent advice" on the use of potassium-fortified salt for the control of hypertension.
Tentative wording was chosen to initiate discussion and advance consensus building stating that the use of potassium-enriched salt (with a composition of
75% sodium chloride and 25% potassium chloride
) "should be recommended to "all patients with hypertension, unless they have advanced kidney disease, are using a potassium supplement, are using a potassium-sparing diuretic, or have another contraindication."
Avoid deaths from excessive salt consumption
"If the world switched from the use of normal salt to salt enriched with potassium,
millions of strokes and heart attacks would be avoided
each year at a very good pace and at a low cost," they emphasized.
"The inclusion of this recommendation follows the trend of other leading societies such as the European one, which in its 2023 arterial hypertension management guide mentions that in adults with hypertension who consume a diet rich in sodium, it is recommended - with a good level of evidence -, replace part of the NaCl (sodium chloride) with KCl (potassium chloride) to reduce blood pressure and the risk of cardiovascular disease,"
Marcelo Choi, member of the Argentine Society of Arterial Hypertension (SAHA), told
Clarín
. did not participate in the study.
Also in dialogue with this newspaper, the Argentine César Romero, who works as a professor in the Department of Medicine at Emory University (in the United States) and is a member of the International Society of Hypertension, considered that the inclusion of recommendations for the use of potassium-enriched salts
"has to be a public health measure
. "
"We have very strong evidence that supplementing potassium salts mixed with table salt
is beneficial
," said Romero, who was also not involved in the work published in the AHA journal.
Among the vast evidence that supports the recommendation, the specialists consulted highlighted that a large study carried out in China was decisive, the results of which were published in 2021 in the New England Journal of Medicine.
In the group that had used a salt substitute (75% sodium chloride and 25% potassium chloride), compared to those who had used common salt, death from any cause was reduced by 12%, the risk of events major cardiovascular events decreased by 13%, and the risk of stroke by 14%, after five years of follow-up.
And a significant reduction in blood pressure
was observed
.
They recommend increasing the intake of foods rich in potassium.
Photo Shutterstock.
This latest evidence "means that there is no more resistance to the fact that salts supplemented with potassium should be included as a public health measure," Romero emphasized.
It would be "a small change" that could have "a very large impact, comparable to what was once done by including iodine chloride in salt to overcome hypothyroidism."
Romero especially emphasized that the risk reduction does not come solely from reducing the amount of sodium.
"In reality ,
the benefit is double
: the amount of sodium is reduced by replacing part of it with potassium chloride, but potassium also has an independent beneficial effect."
"We can counteract the effects of salt in a simple way: by adding potassium, he explained. The mechanism is as follows: "When the body does not have a good amount of potassium, it sets in motion
kidney mechanisms that retain sodium
, this is called switch potassium. (it would be the potassium 'knob') and that has harmful consequences because it increases pressure."
"When we eat a lot of potassium," continued Romero,
"that knob turns off and the kidney begins to eliminate sodium
. That is to say, the benefit of salts supplemented with potassium lies not only in lowering the amount of sodium, but also in the fact that potassium helps lose salt."
"In non-pharmacological treatment, in addition to eating with less salt, there is currently
a lot of emphasis on increasing the consumption of potassium
, fruits and vegetables," highlighted Marcos Marin, former president of the SAHA.
Salts with potassium: what happens to the taste
Potassium-enriched salt can be used as a direct replacement for common salt (sodium chloride) when seasoning, preserving or manufacturing foods.
The authors of the review published in Hypertension highlighted that while other salt reduction strategies make foods taste less salty, for most people the switch to potassium-enriched salt
is imperceptible
.
"Unwanted taste effects are the main reason why efforts to reduce salt consumption have failed for more than two decades. Patients' willingness to continue using potassium-fortified salt removes that barrier, so it may change the rules of the game," enthused one of the study leaders, Professor Aletta Schutte, from the George Institute for Global Health and UNSW Sydney.
In this regard, Choi - who is a doctor specializing in arterial hypertension and a professor at the University of Buenos Aires - stressed that acceptance by consumers is a key aspect, "given that one of the most important properties of salt is
palatability
(that is, it enhances the taste of foods)".
And he agreed with Schutte that the difficulties in maintaining adherence to measures such as eating with less salt.
"Salt substitute represents an alternative. Replacing 25% of the sodium with potassium allows it
to maintain its taste characteristics
and at the same time confers benefits."
The obvious question is why more of the sodium is not replaced by potassium.
And there comes the problem of flavor again.
"Today we have different types of proportions of substitute salts where the replacement of sodium with potassium can reach up to 66 or 75%. The higher the degree of substitution, the lower the acceptability, because potassium ( Although it is a mineral and contributes to the salty taste), unlike sodium, it is associated with
a more bitter and metallic taste
," Choi responded.
What the Argentine guides say
The 2018 Argentine HTA consensus contemplates the benefits of using enriched salts.
"The replacement of common salt with other mineral salts, alone or combined with sodium or each other, such as potassium, calcium and magnesium, may be
partially successful
, considering that the sodium provided by the salt shaker represents a lower percentage of the daily sodium intake. "says the document prepared by the SAHA, the Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC).
"In societies like ours, where sodium consumption comes
mostly from processed foods
, its use at an industrial level would have a great impact at the population level," said Choi.
And she highlighted that at this level, reducing the addition of sodium in products is also key.
In Argentina, there are options for low sodium salts, some with flavorings or herbs, and others with potassium replacement in different proportions.
Professionals advise looking for and reading the labels carefully.
And it must be taken into account that
they are more expensive
than traditional table salt.
"Despite being a very cost-effective measure, access to this type of salt substitute can represent
a barrier for populations with low resources
," acknowledged the doctor specializing in nutrition and high blood pressure.
Foods rich in potassium
In dialogue with
Clarín
, Romero stressed that the benefits of potassium are not acquired only through the use of enriched salts.
"Replacing only table salts with potassium-supplemented salts will not achieve the maximum benefit. We also have to understand that people have to
consume almost twice as much potassium
as they currently do," he stressed.
The goal is
3.5 grams per day
and the Argentine population ingests 2.1, he said.
"Doctors, who have always prohibited things (such as salt consumption), are now learning to recommend people
eat more foods rich in potassium
(generally they are grains - such as lentils -, fruits, vegetables, orange juice, yogurt, milk)."
In Argentina, the labeling law establishes that the amount of sodium is mandatory, but not potassium.
"By knowing how much sodium and potassium a food has, one could quickly tell if one is eating well or poorly. Generally speaking, if the amount of sodium is twice the amount of potassium,
that food is very salty
and is not good for you. And vice versa: if it has more potassium than sodium, the food is good," he noted.
Health professionals can measure through a urinalysis how balanced sodium and potassium intake is.
"If, when dividing the amount of sodium by the amount of potassium, it is greater than 2, it means that the patient is eating twice as much salt as potassium, and must not only reduce the sodium, but also increase the potassium," he concluded.
***
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