Blood Pressure Reduction Effects of Salt Substitutes in Different Application Settings A Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Meta-analysis has been performed on the blood pressure-lowering effect of salt substitutes; however, whether the effects vary by application setting remains unclear. OBJECTIVES: This study aims to compare the blood pressure-lowering effect of salt substitution between home-cooking and collective-cooking settings. METHODS: We searched PubMed, EMBASE, the Cochrane Library, CNKI, and WanFang databases for randomized controlled trials (RCTs) comparing salt substitutes with usual salt on blood pressure, with the last search on June 3-4, 2025. Meta-analysis stratified by application setting was performed. RESULTS: = 0%), respectively. The between-setting difference was significant for SBP (P = 0.008) and borderline significant for DBP (P = 0.099). Sensitivity analyses restricted to high-quality studies or other study subsets, as well as meta-regression adjusting for multiple variables, generally supported these findings. CONCLUSIONS: Replacing usual salt with salt substitutes lowered blood pressure more in the collective-cooking than the home-cooking setting, suggesting that public health policies and strategies should be developed to prioritize full adoption of salt substitutes to maximize its health benefits.