Despite decades of warnings about the dangers of excessive sodium, most Americans with high blood pressure are still not turning to salt substitutes — a simple and inexpensive option to help manage the condition.

A new study presented at the American Heart Association’s meeting in Baltimore revealed that fewer than 6% of U.S. adults report using salt substitutes, a rate that has barely changed in nearly two decades.

“Salt substitute use remained uncommon over the last two decades, including among people with high blood pressure,” said lead researcher Yinying Wei, a doctoral candidate in applied clinical research and hypertension at UT Southwestern Medical Center in Dallas. “Even among individuals with treated and poorly managed or untreated high blood pressure, most continued to use regular salt.”

Salt substitutes replace some or all of the sodium with potassium, offering a flavor similar to regular salt but with less harmful impact on blood pressure. Excess sodium can cause the body to retain fluid, raising blood pressure by drawing more water into the bloodstream. The American Heart Association (AHA) recommends limiting sodium intake to no more than 2,300 milligrams per day — ideally under 1,500 milligrams for most adults.

The research team analyzed data from the National Health and Nutrition Examination Survey collected between 2003 and 2020. Use of salt substitutes peaked during 2013–2014, when just over 5% of U.S. adults reported using them.

Even among groups most likely to benefit, adoption remained limited. Nearly 11% of people taking medications for high blood pressure reported using salt substitutes, followed by just over 7% of those with drug-resistant hypertension. Among people with untreated high blood pressure, usage stayed below 6%.

“These findings highlight an important and easy missed opportunity to improve blood pressure in the U.S.,” said Dr. Amit Khera, clinical chief of cardiology and director of preventive cardiology at UT Southwestern, who was not involved in the study. “The fact that use of salt substitutes remains so low and has not improved in two decades is eye-opening and reminds patients and health care professionals to discuss this option, particularly in visits focused on high blood pressure.”

Researchers stressed that cutting sodium by even 1,000 mg a day can significantly improve heart health. Still, the study underscores how rarely Americans reach for salt substitutes — despite their affordability, availability, and potential to lower blood pressure.

The findings are considered preliminary until published in a peer-reviewed journal.