Researchers tested whether a special salt that contains potassium instead of regular sodium could help people with resistant high blood pressure—the kind that doesn’t respond well to medications. In this 24-week study, 49 adults with this difficult-to-treat condition either used potassium-enriched salt or regular salt in their cooking. The group using the special salt showed slightly better blood pressure reductions, with their systolic (top number) pressure dropping about 2.5 points more than the regular salt group. The special salt appeared safe with no serious side effects, suggesting it could be a helpful addition to other blood pressure treatments.

The Quick Take

  • What they studied: Can a special salt that replaces sodium with potassium help people whose high blood pressure doesn’t respond well to regular medications?
  • Who participated: 49 adults with resistant high blood pressure (blood pressure that stays high even with multiple medications). About half used the special salt and half used regular salt for 6 months.
  • Key finding: People using potassium-enriched salt had their top blood pressure number drop about 2.5 points more than those using regular salt. While this is a small difference, it was in the right direction and appeared safe.
  • What it means for you: If you have hard-to-control high blood pressure, switching to potassium-enriched salt might provide a small additional benefit alongside your medications. However, this is early research with a small group, so talk to your doctor before making changes, especially if you have kidney problems or take certain medications.

The Research Details

This was a randomized controlled trial, which is considered one of the strongest types of research. Researchers randomly assigned 60 adults with resistant high blood pressure to either use a special potassium-enriched salt (containing 50% regular sodium and 50% potassium) or regular salt for 24 weeks. Neither the participants nor the researchers knew who was using which salt until the study ended—this “blinding” helps prevent bias.

Blood pressure was measured in two ways: with a portable monitor worn for 24 hours (which gives a more accurate picture of daily blood pressure) and with traditional office measurements. Researchers also checked urine samples to see how much sodium and potassium participants were actually consuming.

This approach is practical because it tests whether people can actually use this salt substitute in real life, not just in a laboratory setting.

The 24-hour ambulatory blood pressure monitoring is important because office blood pressure readings can be misleading—some people’s pressure goes up just from being at the doctor’s office. The portable monitor gives a truer picture of how well the salt substitute works in everyday life. Testing in people with resistant hypertension matters because these individuals have the most to gain from new treatment options.

This is a well-designed pilot study with good safeguards: it was randomized (reducing bias), double-blinded (neither participants nor researchers knew who got which salt), and used objective measurements. However, it’s a small study with only 49 people who completed it, and 11 people dropped out. The results are borderline statistically significant (P = 0.05), meaning there’s a 5% chance the findings could be due to chance. This is why researchers call it a ‘pilot’ study—it’s meant to test feasibility before doing a larger study.

What the Results Show

After 24 weeks, the group using potassium-enriched salt showed a greater reduction in their 24-hour systolic blood pressure (the top number) compared to the regular salt group, with a difference of about 2.5 mmHg. While this might sound small, for people with resistant high blood pressure, even small improvements matter because their condition is difficult to treat.

The diastolic pressure (bottom number) showed a similar pattern of improvement, though the difference was smaller. Importantly, the potassium-enriched salt group showed increased potassium in their urine, confirming they were actually absorbing the potassium from the special salt.

Office blood pressure readings (taken in a clinic setting) were less consistent and didn’t show as clear a benefit, which is why the 24-hour portable monitor readings are considered more reliable. No one in either group experienced dangerously high potassium levels in their blood, which was a key safety concern.

The study found that sodium excretion (how much regular salt left the body) didn’t change much in either group, suggesting people weren’t dramatically reducing their overall salt intake. This is realistic—people tend to maintain their eating habits. The intervention group’s potassium levels increased appropriately without causing harm. The special salt was well-tolerated with no serious side effects reported, which is encouraging for a potential long-term treatment.

Previous research has shown that reducing sodium and increasing potassium can help lower blood pressure in the general population. However, most studies focused on people with regular high blood pressure, not resistant hypertension. This study is important because it specifically tests whether these strategies work in the harder-to-treat group. The modest benefit found here aligns with what we’d expect from dietary changes—they typically produce smaller improvements than medications but can add up when combined with other treatments.

The study is small (only 49 people completed it), which means the results might not apply to everyone with resistant high blood pressure. The 2.5 mmHg difference is small and right at the edge of statistical significance, meaning it could partly be due to chance. We don’t know if the benefits would continue beyond 24 weeks or if people would stick with the special salt long-term. The study didn’t track whether people actually used the salt substitute consistently. Additionally, the study excluded people with kidney disease or certain medical conditions, so results may not apply to all patients with resistant hypertension.

The Bottom Line

For people with resistant high blood pressure: Potassium-enriched salt substitutes appear safe and may provide a small additional blood pressure benefit when used alongside medications. Consider discussing this option with your doctor as a potential complementary strategy. Confidence level: Moderate (this is early research with small benefits). For the general population: This research doesn’t apply to you unless you have resistant high blood pressure diagnosed by a doctor.

This research is most relevant for people whose high blood pressure remains elevated despite taking multiple blood pressure medications. You should NOT try potassium-enriched salt if you have kidney disease, take ACE inhibitors or ARBs (certain blood pressure medications), or have been told to limit potassium. Always consult your doctor before making dietary changes, especially with salt substitutes.

In this study, the benefits appeared over 24 weeks (6 months). You shouldn’t expect immediate results—if you try this approach, give it at least 2-3 months and have your blood pressure monitored regularly by your doctor. The small benefit size means you might need to combine this with other lifestyle changes (exercise, stress reduction, weight management) for more noticeable improvements.

Want to Apply This Research?

  • Track daily systolic and diastolic blood pressure readings at the same time each day (ideally morning before medication). Record which type of salt you’re using and note any dietary changes. Set a goal to use the potassium-enriched salt in at least 80% of your cooking.
  • Replace your regular salt shaker with potassium-enriched salt and use it in cooking and at the table. Start by using it in one meal per day, then gradually increase. Log each time you use it to build the habit. Set weekly reminders to check your blood pressure at home.
  • Take home blood pressure readings 2-3 times per week at the same time of day. After 4 weeks, compare your average readings to baseline. Share monthly trends with your doctor. Track any side effects or concerns. Continue monitoring even after establishing the habit to ensure consistency and safety.

This research is preliminary and involves a small group of people. The findings should not replace medical advice from your doctor. Before using potassium-enriched salt substitutes, consult your healthcare provider, especially if you have kidney disease, diabetes, heart disease, or take medications like ACE inhibitors, ARBs, potassium-sparing diuretics, or NSAIDs—these combinations can cause dangerously high potassium levels. This study does not provide personalized medical advice. Always work with your doctor to monitor your blood pressure and adjust your treatment plan.