Salt substitution: a low-cost strategy for blood pressure control among rural Chinese. A randomized, controlled trial

J Hypertens. 2007 Oct;25(10):2011-8. doi: 10.1097/HJH.0b013e3282b9714b.


Objective: Dietary sodium and potassium consumption is associated with blood pressure levels. The objective of this study was to define a practical and low-cost method for the control of blood pressure by modification of these dietary cations in rural Chinese.

Methods: This study was a double-blind, randomized, controlled trial designed to establish the long-term effects of a reduced-sodium, high-potassium salt substitute (65% sodium chloride, 25% potassium chloride, 10% magnesium sulphate) compared to normal salt (100% sodium chloride) on blood pressure among high-risk individuals. Following a 4-week run-in period on salt substitute, participants were randomly assigned to replace their household salt with either the study salt substitute or normal salt for a 12-month period.

Results: The mean age of the 608 randomized participants was 60 years and 56% of them were female. Sixty-four percent had a history of vascular disease and 61% were taking one or more blood pressure-lowering drugs at entry. Mean baseline blood pressure was 159/93 mmHg (SD 26/14). The mean overall difference in systolic blood pressure between randomized groups was 3.7 mmHg (95% confidence interval 1.6-5.9, P < 0.001). There was strong evidence that the magnitude of this reduction increased over time (P = 0.001) with the maximum net reduction of 5.4 mmHg (2.3-8.5) achieved at 12 months. There were no detectable effects on diastolic blood pressure.

Conclusion: Salt substitution produced a substantial and sustained systolic blood pressure reduction in this population, and should be actively promoted as a low-cost alternate or adjunct to drug therapy for people consuming significant quantities of salt.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Blood Pressure / drug effects
  • China
  • Double-Blind Method
  • Female
  • Humans
  • Hypertension / diet therapy*
  • Hypertension / physiopathology
  • Hypertension / prevention & control
  • Magnesium Sulfate / administration & dosage
  • Magnesium Sulfate / adverse effects
  • Male
  • Middle Aged
  • Potassium Chloride / administration & dosage
  • Potassium Chloride / adverse effects
  • Risk Factors
  • Rural Population
  • Sodium Chloride, Dietary / administration & dosage*
  • Sodium Chloride, Dietary / adverse effects


  • Sodium Chloride, Dietary
  • Potassium Chloride
  • Magnesium Sulfate