Effects of salt substitute on urinary electrolytes and blood pressure in a real-world setting-cohort study in Hunan, China

Salt substitute is considered an effective strategy to reduce sodium and increase potassium intake and thereby lower blood pressure in China, but its benefits and risks are uncertain in real-world data. This study is designed to compare the difference in the 1-year efficacy of salt substitute and salt restriction on urinary electrolytes and blood pressure. A total of 2,929 and 2,071 participants with the 24-h estimated urinary sodium excretion (eUNaE) above 2.36 g/d using salt substitute (SS) and salt restriction (SR) strategies, respectively, were followed for 1 year. Salt substitute users were further divided by potassium chloride (KCl) content (13% vs 25%) and duration (9-11 vs 12 months). The 24-h eUNaE and estimated urinary potassium excretion (eUKE) levels were calculated using the Kawasaki formula from spot urine sample. The SS group ( = 1,897) had lower eUNaE (3.82 ± 1.03 vs 4.05 ± 1.01 g/day,