2023-04-20 21:21:22
Why is this important?
Reducing sodium intake and substituting salt have been described as valuable non-pharmacological interventions for lowering blood pressure. But the data concerning this second alternative, which has been little compared to the first, are scarce in the elderly. Furthermore, the associated risk of hyperkalaemia is poorly established. It was therefore interesting to conduct a study aimed at determining and comparing the efficacy and safety of the two strategies in adults living in residences for the elderly.
Methodology
DECIDE-Salt recruited 48 Chinese establishments, which were randomized (1:1:1:1) between different modalities: substitution or usual table salt, with or without gradual reduction in the amounts over the two years. Those assigned to the substitution group received a salt substitute (62.5% sodium chloride, 25% potassium chloride, 12.5% flavorings) and those assigned to the control group received usual salt (100% sodium chloride). The cooks were not to use other sources of salt during the two years of the study. For those who were to conduct a gradual reduction in consumption, the objective was to achieve a 40% reduction by the end of the intervention, at the rate of 5-10% every 3 months. The population studied corresponded to residents aged 55 or over whose BP could be measured on inclusion and who remained residents for at least 2 years. Residents with hyperkalaemia were excluded and a follow-up at 6, 12, 18 and 24 months was organised.
Principle results
A total of 1,612 eligible participants were included in the study (mean age 71.0 years, 76.3% male): of these, 62.1% had a history of high blood pressure, 29.1% history of stroke or coronary heart disease and 19.4% of non-vascular health conditions. The mean SBP and DBP value at inclusion was 137.5/80.5mmHg.
In establishments that carried out salt substitution, the mean SBP was lower than in those that continued to consume table salt (-7.1 mmHg [-10,5 à -3,8]), the effects being on average greater in women than in men. In establishments having gradually restricted consumption (of salt or substitute), no statistically significant difference was observed, despite a trend at 24 months.
Similarly, salt substitution led to reduced DBP (-1.9 mmHg [-3,6 à -0,2]) and a lower rate of cardiovascular events (hazard ratio 0.60 [0,38-0,96]) with no effect on mortality.
In terms of tolerance, the salt substitute led to an increase in mean serum potassium (0.26 mmol/L) and a decrease in serum sodium (-0.92 mmol/L, p<0.001 in both cases ). Also, hyperkalemia was noted in 7.0% of patients on substitution, against 2.4% among the others (hazard ratio 3.29 [1,45-7,45]p=0.004) with a concomitant decrease in the risk of hypokalaemia.
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