Comparative effects of salt substitutes on blood pressure, cardiovascular events and mortality: a systematic review and network meta-analysis
Salt substitutes, particularly moderate-potassium and low-sodium formulations, represent a promising sodium reduction strategy. However, current evidence for mortality and cardiovascular event benefits is dominated by one large Chinese trial and has very limited generalisability beyond Chinese populations with high discretionary salt use. These products appear acceptable and safe in people without renal impairment, but clinicians should rule out kidney disease and hyperkalaemia risk before recommending them, and large trials in non-Chinese populations are needed.
Authors
- Bradley C. Johnston (ORCID: https://orcid.org/0000-0001-8872-8626)
- Jinhui Tian (ORCID: https://orcid.org/0000-0002-7082-3569)
- Honghao Lai
- Gihad Nesrallah (ORCID: https://orcid.org/0000-0002-2280-3811)
- N R Campbell
- Weilong Zhao (ORCID: https://orcid.org/0000-0001-8909-5322)
- Jiajie Huang
- R W M Vernooij
- Bei Pan
- Gordon H. Guyatt
- Long Ge
- Kehu Yang
Institutions
- University of Toronto (CA)
- Utrecht University (NL)
- Texas College (US)
- Humber River Regional Hospital (CA)
- University Medical Center Utrecht (NL)
- Longgang Central Hospital (CN)
- Ministry of Education (BD)
- Impact (CA)
- Libin Cardiovascular Institute of Alberta (CA)
- Lanzhou University (CN)
- Texas A&M University (US)
- McMaster University (CA)
Publication Details
- Journal
- BMC Medicine
- Published
- 2026-01-23
- DOI
- https://doi.org/10.1186/s12916-026-04635-z
- Primary Topic
- Sodium Intake and Health
- Type
- article
- Field-Weighted Citation Impact
- 0.00