The hypotensive effect of salt substitutes in stage 2 hypertension: a systematic review and meta-analysis

Sadegh Jafarnejad, Hamed Mirzaei, Cain C T Clark, Mohsen Taghizadeh, Armin Ebrahimzadeh

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    9 Citations (Scopus)
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    Background: Hypertension (HTN) is a ubiquitous risk factor for numerous non-communicable diseases, including cardiovascular disease and stroke. There are currently no wholly effective pharmacological therapies for subjects with HTN. However, salt substitutes have emerged as a potential therapy for the treatment of HTN. The aim of the present study was to assess the effect of salt substitutes on reducing systolic blood pressure (SBP) and diastolic BP (DBP), following a meta-analysis of randomized controlled trials. Methods: Studies were found via systematic searches of the Pubmed/Medline, Scopus, Ovid, Google Scholar and Cochrane library. Ten studies, comprised of 11 trials and 1119 participants, were included in the meta-analysis. Results: Pooled weighted mean differences showed significant reductions of SBP (WMD - 8.87 mmHg; 95% CI - 11.19, - 6.55, p < 0.001) and DBP (WMD - 4.04 mmHg; 95% CI - 5.70, - 2.39) with no statistically significant heterogeneity between the 11 included comparisons of SBPs and DBPs. The stratified analysis of trials based on the mean age of participants showed a significant reduction in the mean difference of SBP in both adults (< 65 years old) and elderly (≥65 years old). However, the DBP-lowering effect of salt substitutes was only observed in adult patients (WMD - 4.22 mmHg; 95% CI - 7.85, - 0.58), but not in the elderly subjects. Conclusions: These findings suggest that salt-substitution strategies could be used for lowering SBP and DBP in patients with stage 2 HTN; providing a nutritional platform for the treatment, amelioration, and prevention of HTN.

    Original languageEnglish
    Article number98
    Number of pages15
    JournalBMC Cardiovascular Disorders
    Publication statusPublished - 27 Feb 2020

    Bibliographical note

    © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
    International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
    ( applies to the data made available in this article, unless otherwise stated.


    • Diastolic blood pressure
    • Hypertension
    • Meta-analysis
    • Salt substitutes
    • Systolic blood pressure

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine


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