Cardiovascular Atlas
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Salt substitution (lower-sodium, potassium-containing salt)

Swapping ordinary table salt for a salt that has part of its sodium replaced with potassium. The aim is lower blood pressure and, over years, fewer strokes. In SSaSS, a trial in rural China among people with a past stroke or aged 60 or over with high blood pressure, villages that used a substitute had fewer strokes and deaths than villages that kept regular salt. WHO suggests adults in general populations use these products if they use table salt, but not people with kidney problems, children or pregnant women. The NICE hypertension guideline says potassium-containing substitutes should not be used by some groups, including older people and people with diabetes. These positions are shown side by side and are not merged.

Also called Lower-sodium salt substitutes · LSSS

  • Intervention
  • In this atlas

Overview

Technical summary

Replaces part of the sodium chloride in table salt with potassium chloride. SSaSS used 75% sodium chloride and 25% potassium chloride by mass. WHO reviewed 26 randomized trials; in the 23 whose substitutes replaced sodium with potassium, sodium chloride ranged from 41 to 75% and potassium chloride from 19 to 50%. WHO notes that the blood-pressure-lowering effect is partly due to the potassium content, and that too much blood potassium (hyperkalaemia) may be harmful, especially with impaired kidney function. Claims: SSaSS stroke, death and hyperkalemia results in one rural Chinese population; WHO 2025 conditional recommendation (direction for); NICE NG136 1.4.5 caution (direction against) in a subgroup context.

About this intervention

Type
Lifestyle
Mechanism
Lowers sodium intake and raises potassium intake.

Claims and evidence

Context Adults in general populations, not pregnant, without kidney impairment (WHO 2025 salt-substitute guideline)

Recipient
Adult
Population
Adults in general populations. The recommendation excludes pregnant women, children, and people with kidney impairment or other circumstances or conditions that might compromise potassium excretion.
Care setting
Not stated as a care setting. The recommendation concerns table salt that a person adds to food while cooking or eating.
Geography
Global guideline; no country is specified
Life stage
Adult; the guideline states no age bounds and excludes children
Follow-up
Not applicable (recommendation context). The trials behind it followed adults from 56 days to 5 years.
Eligibility: 1 inclusion criterion; 5 exclusion criteria
Included
  • Adults in general populations who choose to use table salt
Excluded
  • Pregnant women
  • Children
  • People with kidney impairment
  • People with other circumstances or conditions that might compromise potassium excretion
  • Households where a member is at risk of hyperkalaemia, for family meals

  • Recommendation Guidance Low certainty

    If adults in a general population choose to use table salt, WHO suggests replacing regular table salt with a lower-sodium salt substitute that contains potassium. This is a conditional recommendation, made alongside WHO's strong recommendation to keep sodium intake below 2 g a day. It is not intended for pregnant women, children, or people with kidney impairment or other conditions that might make it harder to clear potassium.

    Applies to Adult
    • Adults in general populations. The recommendation excludes pregnant women, children, and people with kidney impairment or other circumstances or conditions that might compromise potassium excretion.
    • Not stated as a care setting. The recommendation concerns table salt that a person adds to food while cooking or eating.
    • Global guideline; no country is specified
    • Adult; the guideline states no age bounds and excludes children
    Follow-up Not applicable (recommendation context). The trials behind it followed adults from 56 days to 5 years.
    Certainty method
    Stated by WHO in the guideline rationale, which describes the evidence behind this recommendation as "moderate-to-low certainty (an assessment of low certainty overall ...)". The atlas records the overall assessment, low. This is WHO's assessment, not an atlas reviewer judgement.
    Limitations
    WHO describes the evidence behind the recommendation as "moderate-to-low certainty (an assessment of low certainty overall ...)". The per-outcome levels are in WHO's Annex 6 GRADE table, which this record does not extract. It covers table salt that a person adds to food, not condiments such as soy sauce or sodium already in manufactured foods and restaurant meals. All trials in WHO's review excluded people who could be harmed by extra potassium and some also excluded people with diabetes, so evidence for those groups is uncertain. WHO says reducing sodium from all sources is the preferred strategy, and that a household member at risk of hyperkalaemia should not have food prepared with a substitute. It is recorded beside the NICE caution and does not resolve it.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (9)

    1. Supports Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, WHO recommendation box, page ix (recommendation sentence)
      How it applies
      The recommendation as worded, with its condition.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    2. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, WHO recommendation box, page ix (scope sentences)
      How it applies
      Adults, not pregnant women or children, excluding kidney impairment.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    3. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, Scope of the recommendation, page ix
      How it applies
      Discretionary use of table salt only; condiments are outside the scope.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    4. Supports Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, Rationale, first bullet, page xi
      How it applies
      WHO states low certainty overall under GRADE.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    5. Supports Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, Rationale, bullet 5, page xii
      How it applies
      WHO says the recommendation is conditional because the certainty was low.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    6. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, The evidence, page viii
      How it applies
      Trials excluded people who could be harmed by extra potassium.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    7. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, Remarks, bullet 1, page xii
      How it applies
      Reducing sodium from all sources is preferred.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    8. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, Remarks, last bullet, page xiii
      How it applies
      Household members at risk of hyperkalaemia.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    9. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Page header, date line
      How it applies
      Publication date shown on the WHO page.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      45cb6814f63da77e114e3dbc744dc1b8e2295a14f12cd9bc8c289216407d2c47
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

Context Adults with suspected or diagnosed hypertension who are older, have diabetes or kidney disease, or take some blood-pressure medicines (NICE NG136 recommendation 1.4.5)

Recipient
Adult
Population
Adults with suspected or diagnosed hypertension in the groups NICE names for potassium chloride salt substitutes: older people (NICE gives no age), people with diabetes, people with kidney disease, and people on some blood-pressure medicines (for example ACE inhibitors and angiotensin II receptor blockers). The recommendation says people and sits in the lifestyle section addressed to people with suspected or diagnosed hypertension. NICE also names pregnant women; that group is outside this context and belongs to the maternal atlas.
Care setting
Not stated on the fetched page
Geography
England, from clause 6 of the NICE terms and conditions, which presents the information as support for people in England who make decisions about funding care. Clause 8 adds that NICE does not write its content as a basis for decisions outside the United Kingdom. The NG136 page itself states no jurisdiction.
Life stage
Adult; older people are named but NICE gives no age bound
Follow-up
Not applicable (recommendation context)
Eligibility: 2 inclusion criteria; 1 exclusion criterion
Included
  • Adult with suspected or diagnosed hypertension
  • At least one of: older age, diabetes, kidney disease, or taking some antihypertensive drugs such as ACE inhibitors or angiotensin II receptor blockers
Excluded
  • Pregnant women are named by NICE but belong to the maternal atlas

  • Recommendation Guidance Certainty not assessed

    NICE guideline NG136 advises encouraging people to keep their sodium intake low, either by cutting back on salt or by using a salt substitute in its place. It adds that older people, people with diabetes, people with kidney disease, and people on some blood-pressure medicines (for example ACE inhibitors and angiotensin II receptor blockers) should not use salt substitutes that contain potassium chloride, and says these groups should be encouraged to cut down on salt instead. The recommendation is tagged as dating from 2004 and amended in 2019, so it predates the SSaSS report and the WHO salt-substitute guideline, which are recorded separately. NICE also names pregnant women in this list; that group is outside this claim context and belongs to the maternal atlas.

    Applies to Adult
    • Adults with suspected or diagnosed hypertension in the groups NICE names for potassium chloride salt substitutes: older people (NICE gives no age), people with diabetes, people with kidney disease, and people on some blood-pressure medicines (for example ACE inhibitors and angiotensin II receptor blockers). The recommendation says people and sits in the lifestyle section addressed to people with suspected or diagnosed hypertension. NICE also names pregnant women; that group is outside this context and belongs to the maternal atlas.
    • Not stated on the fetched page
    • England, from clause 6 of the NICE terms and conditions, which presents the information as support for people in England who make decisions about funding care. Clause 8 adds that NICE does not write its content as a basis for decisions outside the United Kingdom. The NG136 page itself states no jurisdiction.
    • Adult; older people are named but NICE gives no age bound
    Follow-up Not applicable (recommendation context)
    Certainty method
    Not assessed
    Limitations
    The fetched page gives no reasoning for the caution, and the NICE rationale was not read. It says people, and sits in the lifestyle section whose first recommendation is addressed to people who may have hypertension or have been diagnosed with it. Older people has no age bound. What the 2019 amendment changed was not checked. The wording is imperative with no NICE strength label, and its meaning was not verified. The NG136 page states no jurisdiction. NICE's terms present the information as support for people in England who make decisions about funding care, and say the content is not written as a basis for decisions outside the United Kingdom. The page shows a last update of 26 February 2026. NICE's reuse terms limit outside use of its wording, so this atlas states the caution in its own words. This caution and the WHO suggestion are shown side by side; neither is shown to be right.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (7)

    1. Supports Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Recommendation 1.4.5, sentence 2
      How it applies
      The caution on potassium chloride salt substitutes and the groups it names.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    2. Supports Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Recommendation 1.4.5, sentence 1
      How it applies
      The advice to keep sodium low by reducing or substituting salt.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    3. Supports Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Recommendation 1.4.5, sentence 3 and tag
      How it applies
      Advice to reduce salt in these groups, with the 2004 and 2019 tag.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    4. Background Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Recommendation 1.4.1 and section 1.4 heading
      How it applies
      The section the recommendation sits in addresses people with suspected or diagnosed hypertension.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    5. Background Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter

      Guideline · National Institute for Health and Care Excellence (NICE) · Edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked. · Published 2019-08-28 · nice: NG136

      Locator
      Page header, Published and Last updated
      How it applies
      Guideline first published 28 August 2019, last updated 26 February 2026.
      Retrieved
      Source effective date
      2026-02-26
      Source state
      Current
      Snapshot hash
      68ce72f3487ffa4715f92ddfa8aaf6e093f5aecd3598cd59a0ab58f74ce86f28
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. NICE's terms and conditions (source cardio:nice-terms-and-conditions, fetched 2026-10-11) make NICE content available for reuse in the United Kingdom only. Outside the United Kingdom, apart from private use, study or one's own research, reuse needs NICE's prior written agreement, which may carry a licence and a fee, and use for artificial intelligence needs approval and a licensing arrangement. The terms also say NICE does not write its content as a basis for decisions outside the United Kingdom. The page bytes are not committed.

    6. Background NICE terms and conditions, including the Notice of Rights

      Webpage · National Institute for Health and Care Excellence (NICE) · Edition The page as fetched on 2026-10-11. It shows no version date; its footer carries the year 2026.

      Locator
      Clause 6, sentence 1
      How it applies
      Source of the England audience read for this claim.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      663d4a4be632810ae88513ec6386193a7b373159e5e2ecd4ec61419e2e4c408a
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. This page sets the terms under which NICE content may be reused; its wording is kept in research/cluster-b/quotes.tsv as internal evidence and is not published. The page bytes are not committed.

    7. Background NICE terms and conditions, including the Notice of Rights

      Webpage · National Institute for Health and Care Excellence (NICE) · Edition The page as fetched on 2026-10-11. It shows no version date; its footer carries the year 2026.

      Locator
      Clause 8
      How it applies
      Source of the United Kingdom reliance limit read for this claim.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      663d4a4be632810ae88513ec6386193a7b373159e5e2ecd4ec61419e2e4c408a
      Reuse basis
      Public text is cite_only (Ben's decision of 2026-10-13 (medical-atlas-core issue 2)): public pages state the facts in the atlas's own words, with a citation and a link, and use no NICE wording. This page sets the terms under which NICE content may be reused; its wording is kept in research/cluster-b/quotes.tsv as internal evidence and is not published. The page bytes are not committed.

Context People with a past stroke, or aged 60 or over with high blood pressure, in rural Chinese villages (SSaSS)

Recipient
Recipient not specified
Population
People who had had a stroke, or who were 60 years of age or older and had high blood pressure, living in rural villages in China. The registry defines high blood pressure as uncontrolled: systolic 140 mmHg or more on treatment, or 160 mmHg or more without treatment. In the trial 72.6% had a history of stroke and 88.4% a history of hypertension, and the mean age was 65.4 years. No source read gives a minimum age, and the past-stroke group has no stated age floor, so the recipient is recorded as unknown rather than adult. Pregnancy is not mentioned in the sources read.
Care setting
Rural villages in China, 600 of them. The registry names five Northern Chinese provinces and Tibet. A household phone was an entry requirement.
Geography
Rural China: five Northern Chinese provinces and Tibet (registry description)
Life stage
Mixed ages with a mean of 65.4 years. Age 60 or over is required for people without a past stroke; no age floor is stated for people with one.
Gestational age
Not reported
Postnatal age
Not reported
Follow-up
Mean follow-up 4.74 years (abstract). The registry gives a time frame of 5 years.
Eligibility: 3 inclusion criteria; 7 exclusion criteria
Included
  • Past stroke, or aged 60 years or over with uncontrolled high blood pressure (systolic 140 mmHg or more on blood-pressure medicine, 160 mmHg or more without)
  • Abstract wording: a history of stroke, or 60 years of age or older with high blood pressure
  • A phone owned by the participant or a household member
Excluded
  • Participant or family member using a potassium-sparing diuretic
  • Participant or family member using a potassium supplement
  • Participant or family member with serious renal impairment
  • Participant or family member with another reason for concern about using a salt substitute
  • Participant eats most meals outside the home
  • Not expected to live longer than 6 months, as estimated by the village doctor
  • Another family member in the same household already included

  • Safety Interventional Certainty not assessed

    In SSaSS, serious adverse events attributed to hyperkalemia (too much potassium in the blood) were not significantly more frequent with the salt substitute: 3.35 events per 1000 person-years against 3.30 with regular salt (rate ratio 1.04, 95% CI 0.80 to 1.37). Not significantly higher is not the same as no difference or no risk.

    Applies to Recipient not specified
    • People who had had a stroke, or who were 60 years of age or older and had high blood pressure, living in rural villages in China. The registry defines high blood pressure as uncontrolled: systolic 140 mmHg or more on treatment, or 160 mmHg or more without treatment. In the trial 72.6% had a history of stroke and 88.4% a history of hypertension, and the mean age was 65.4 years. No source read gives a minimum age, and the past-stroke group has no stated age floor, so the recipient is recorded as unknown rather than adult. Pregnancy is not mentioned in the sources read.
    • Rural villages in China, 600 of them. The registry names five Northern Chinese provinces and Tibet. A household phone was an entry requirement.
    • Rural China: five Northern Chinese provinces and Tibet (registry description)
    • Mixed ages with a mean of 65.4 years. Age 60 or over is required for people without a past stroke; no age floor is stated for people with one.
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Mean follow-up 4.74 years (abstract). The registry gives a time frame of 5 years.
    Certainty method
    Not assessed
    Limitations
    The abstract names clinical hyperkalemia as the safety outcome and reports serious adverse events attributed to it. The registry excluded households using potassium-sparing diuretics or potassium supplements and people with serious renal impairment, so the result does not speak to those groups. WHO notes that all trials in its review excluded people who might be harmed by extra potassium. One open-label, cluster-randomized trial in rural China. The result applies to people who had had a stroke or were 60 or over with high blood pressure and met the other entry rules, such as no potassium-sparing diuretic, potassium supplement or serious kidney impairment in the household. It does not show the same effect in other groups or places. The tested package is ongoing dietary advice plus the substitute, compared with dietary advice at baseline only (registry). The abstract calls the trial open-label, while the registry records masking as DOUBLE (investigator and outcomes assessor); the two are not reconciled. The registry counts 20996 participants and the abstract 20,995; the reason is unknown. Only the abstract and the registry were read: the NEJM full text returned HTTP 403 and no open copy exists, so event counts, person-years, per-arm intervals and any correction are not recorded.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (5)

    1. Supports Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, RESULTS, sentence 5
      How it applies
      Abstract of the main report, for the same population and follow-up as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    2. Background Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, METHODS, sentence 4
      How it applies
      Names clinical hyperkalemia as the safety outcome.
      Retrieved
      Source effective date
      Not reported
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      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    3. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.eligibilityModule.eligibilityCriteria, exclusion
      How it applies
      Registry exclusions on potassium-sparing diuretics, potassium supplements and serious renal impairment.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    4. Background Use of lower-sodium salt substitutes: WHO guideline

      Guideline · World Health Organization · Edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025. · Published 2025-01-27 · isbn: 978-92-4-010559-1

      Locator
      Executive summary, The evidence, page viii
      How it applies
      WHO says all trials in its review excluded people who could be harmed by extra potassium.
      Retrieved
      Source effective date
      Not reported
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      Current
      Snapshot hash
      e7111969908bbf588c20b457b6f5f26ce16e6d9e023e7e179d8a9c1b54a318a0
      Reuse basis
      CC BY-NC-SA 3.0 IGO, stated in the PDF. Short quotations with attribution only, until the atlas settles its public data licence. Hashes only; the page and the PDF are not committed.

    5. Background Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, METHODS, sentences 1 to 3
      How it applies
      Design, population, villages and what each arm used.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

  • Effect Interventional Certainty not assessed

    In the same trial and time window, deaths from any cause were less frequent with the salt substitute: 39.28 events per 1000 person-years against 44.61 with regular salt (rate ratio 0.88, 95% CI 0.82 to 0.95). Death from any cause was a secondary outcome.

    Applies to Recipient not specified
    • People who had had a stroke, or who were 60 years of age or older and had high blood pressure, living in rural villages in China. The registry defines high blood pressure as uncontrolled: systolic 140 mmHg or more on treatment, or 160 mmHg or more without treatment. In the trial 72.6% had a history of stroke and 88.4% a history of hypertension, and the mean age was 65.4 years. No source read gives a minimum age, and the past-stroke group has no stated age floor, so the recipient is recorded as unknown rather than adult. Pregnancy is not mentioned in the sources read.
    • Rural villages in China, 600 of them. The registry names five Northern Chinese provinces and Tibet. A household phone was an entry requirement.
    • Rural China: five Northern Chinese provinces and Tibet (registry description)
    • Mixed ages with a mean of 65.4 years. Age 60 or over is required for people without a past stroke; no age floor is stated for people with one.
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Mean follow-up 4.74 years (abstract). The registry gives a time frame of 5 years.
    Certainty method
    Not assessed
    Limitations
    Secondary outcome. The limits of the stroke claim apply: One open-label, cluster-randomized trial in rural China. The result applies to people who had had a stroke or were 60 or over with high blood pressure and met the other entry rules, such as no potassium-sparing diuretic, potassium supplement or serious kidney impairment in the household. It does not show the same effect in other groups or places. The tested package is ongoing dietary advice plus the substitute, compared with dietary advice at baseline only (registry). The abstract calls the trial open-label, while the registry records masking as DOUBLE (investigator and outcomes assessor); the two are not reconciled. The registry counts 20996 participants and the abstract 20,995; the reason is unknown. Only the abstract and the registry were read: the NEJM full text returned HTTP 403 and no open copy exists, so event counts, person-years, per-arm intervals and any correction are not recorded.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (6)

    1. Supports Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, RESULTS, sentence 4 (death)
      How it applies
      Abstract of the main report, for the same population and follow-up as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    2. Supports Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, RESULTS, sentence 3
      How it applies
      Mean follow-up stated in the abstract.
      Retrieved
      Source effective date
      Not reported
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      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    3. Background Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, METHODS, sentences 1 to 3
      How it applies
      Design, population, villages and what each arm used.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    4. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.armsInterventionsModule.armGroups and interventions[0].description
      How it applies
      Registry description of the two arms: ongoing advice plus the substitute, versus advice at baseline only.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    5. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.designModule.designInfo.maskingInfo
      How it applies
      The registry records masking as DOUBLE (investigator and outcomes assessor); the abstract says open-label. Not reconciled.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    6. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.designModule.enrollmentInfo.count
      How it applies
      Registry enrollment 20996, against 20,995 in the abstract. Not reconciled.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

  • Effect Interventional Certainty not assessed

    In SSaSS, in rural Chinese villages, people who had had a stroke or were 60 or older with high blood pressure had fewer strokes when their village used a lower-sodium, potassium-enriched salt substitute, with ongoing dietary advice, than when it kept using regular salt. Over a mean follow-up of 4.74 years the stroke rate was 29.14 events per 1000 person-years with the substitute and 33.65 with regular salt (rate ratio 0.86, 95% CI 0.77 to 0.96).

    Applies to Recipient not specified
    • People who had had a stroke, or who were 60 years of age or older and had high blood pressure, living in rural villages in China. The registry defines high blood pressure as uncontrolled: systolic 140 mmHg or more on treatment, or 160 mmHg or more without treatment. In the trial 72.6% had a history of stroke and 88.4% a history of hypertension, and the mean age was 65.4 years. No source read gives a minimum age, and the past-stroke group has no stated age floor, so the recipient is recorded as unknown rather than adult. Pregnancy is not mentioned in the sources read.
    • Rural villages in China, 600 of them. The registry names five Northern Chinese provinces and Tibet. A household phone was an entry requirement.
    • Rural China: five Northern Chinese provinces and Tibet (registry description)
    • Mixed ages with a mean of 65.4 years. Age 60 or over is required for people without a past stroke; no age floor is stated for people with one.
    • Gestational age Not reported
    • Postnatal age Not reported
    Follow-up Mean follow-up 4.74 years (abstract). The registry gives a time frame of 5 years.
    Certainty method
    Not assessed
    Limitations
    One open-label, cluster-randomized trial in rural China. The result applies to people who had had a stroke or were 60 or over with high blood pressure and met the other entry rules, such as no potassium-sparing diuretic, potassium supplement or serious kidney impairment in the household. It does not show the same effect in other groups or places. The tested package is ongoing dietary advice plus the substitute, compared with dietary advice at baseline only (registry). The abstract calls the trial open-label, while the registry records masking as DOUBLE (investigator and outcomes assessor); the two are not reconciled. The registry counts 20996 participants and the abstract 20,995; the reason is unknown. Only the abstract and the registry were read: the NEJM full text returned HTTP 403 and no open copy exists, so event counts, person-years, per-arm intervals and any correction are not recorded.
    Last checked
    Not recorded
    Next evidence check due
    Not scheduled
    Sources and citations (7)

    1. Supports Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, RESULTS, sentence 4
      How it applies
      Abstract of the main report, for the same population and follow-up as this context.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    2. Supports Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, RESULTS, sentence 3
      How it applies
      Mean follow-up stated in the abstract.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    3. Supports Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, CONCLUSIONS, sentence 1
      How it applies
      The authors conclude for the same population.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    4. Background Effect of Salt Substitution on Cardiovascular Events and Death

      Publication · Massachusetts Medical Society (N Engl J Med 385(12):1067-1077) · Edition Abstract only, from PubMed, fetched 2026-10-11. The published date is the print issue date; PubMed also gives an electronic publication date of 2021-08-29. The version of record at nejm.org returned HTTP 403. Europe PMC reports the article as not open access and not in PMC. · Published 2021-09-16 · doi: 10.1056/NEJMoa2105675

      Locator
      Abstract, METHODS, sentences 1 to 3
      How it applies
      Design, population, villages and what each arm used.
      Retrieved
      Source effective date
      Not reported
      Source state
      Current
      Snapshot hash
      81ecee71f40d1529e615632d4873d8288566233e5de0fa8bfbf25db8c5ace858
      Reuse basis
      Bibliographic metadata and short factual extraction with quotations under 25 words. The Crossref license link points to NEJM terms of use. Full text not accessed; nothing committed.

    5. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.armsInterventionsModule.armGroups and interventions[0].description
      How it applies
      Registry description of the two arms: ongoing advice plus the substitute, versus advice at baseline only.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    6. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.designModule.designInfo.maskingInfo
      How it applies
      The registry records masking as DOUBLE (investigator and outcomes assessor); the abstract says open-label. Not reconciled.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

    7. Background China Salt Substitute and Stroke Study

      Registry · U.S. National Library of Medicine (ClinicalTrials.gov) · Edition Record last posted 2021-04-08, status verified 2021-04, fetched 2026-10-11. The JSON has no results section. · nct: NCT02092090

      Locator
      protocolSection.designModule.enrollmentInfo.count
      How it applies
      Registry enrollment 20996, against 20,995 in the abstract. Not reconciled.
      Retrieved
      Source effective date
      2021-04-08
      Source state
      Current
      Snapshot hash
      7fb59c0de28942b6334a4072776326676f525b7454e1d33a3c60ee6c7c4cf6d3
      Reuse basis
      Registry record, hash only. The ClinicalTrials.gov terms page is rendered by JavaScript and was not read, so the redistribution basis is unverified. The raw JSON is not committed, because that basis is unverified. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) that registries allow short quotations with attribution. This source's terms are unverified or reserve all rights, so any quotation stays short.

Guidance

Recommended against: Salt substitution (lower-sodium, potassium-containing salt)

Applies to Adult
  • Adults with suspected or diagnosed hypertension in the groups NICE names for potassium chloride salt substitutes: older people (NICE gives no age), people with diabetes, people with kidney disease, and people on some blood-pressure medicines (for example ACE inhibitors and angiotensin II receptor blockers). The recommendation says people and sits in the lifestyle section addressed to people with suspected or diagnosed hypertension. NICE also names pregnant women; that group is outside this context and belongs to the maternal atlas.
  • Not stated on the fetched page
  • England, from clause 6 of the NICE terms and conditions, which presents the information as support for people in England who make decisions about funding care. Clause 8 adds that NICE does not write its content as a basis for decisions outside the United Kingdom. The NG136 page itself states no jurisdiction.
  • Adult; older people are named but NICE gives no age bound
Follow-up Not applicable (recommendation context)
Issued by
National Institute for Health and Care Excellence
Guideline
Hypertension in adults: diagnosis and management (NICE guideline NG136), Recommendations chapter, edition The Recommendations chapter as shown on 2026-10-09 and fetched again on 2026-10-11 with identical bytes. The page header gives 26 February 2026 as the last update. This atlas cites six recommendations from it, each with the version tag the page shows: 1.1.3 is tagged [2004]; 1.2.3, 1.2.4 and 1.2.8 are tagged [2019]; 1.4.5 is tagged [2004, amended 2019]; 1.4.20 is tagged [2019, amended 2022]. Which edition of each recommendation these tags point to was not checked.
Strength
Not labeled on the fetched page. The caution uses the wording should not be used. (Not stated on the fetched NG136 page. The caution is imperative wording with no NICE strength label, and how NICE treats this wording was not verified.)
Effective
2019-08-28 (The date NG136 was first published. Recommendation 1.4.5 is tagged [2004, amended 2019], so it predates the guideline publication date. The page shows a last update of 26 February 2026.)
Jurisdiction
England, from clause 6 of the NICE terms and conditions, which presents the information as support for people in England who make decisions about funding care. Clause 8 adds that NICE does not write its content as a basis for decisions outside the United Kingdom. The NG136 page itself states no jurisdiction.
Basis
NICE guideline NG136 advises encouraging people to keep their sodium intake low, either by cutting back on salt or by using a salt substitute in its place. It adds that older people, people with diabetes, people with kidney disease, and people on some blood-pressure medicines (for example ACE inhibitors and angiotensin II receptor blockers) should not use salt substitutes that contain potassium chloride, and says these groups should be encouraged to cut down on salt instead. The recommendation is tagged as dating from 2004 and amended in 2019, so it predates the SSaSS report and the WHO salt-substitute guideline, which are recorded separately. NICE also names pregnant women in this list; that group is outside this claim context and belongs to the maternal atlas.

Limitations. The fetched page gives no reasoning for the caution, and the NICE rationale was not read. It says people, and sits in the lifestyle section whose first recommendation is addressed to people who may have hypertension or have been diagnosed with it. Older people has no age bound. What the 2019 amendment changed was not checked. The wording is imperative with no NICE strength label, and its meaning was not verified. The NG136 page states no jurisdiction. NICE's terms present the information as support for people in England who make decisions about funding care, and say the content is not written as a basis for decisions outside the United Kingdom. The page shows a last update of 26 February 2026. NICE's reuse terms limit outside use of its wording, so this atlas states the caution in its own words. This caution and the WHO suggestion are shown side by side; neither is shown to be right.

Recommended: Salt substitution (lower-sodium, potassium-containing salt)

Applies to Adult
  • Adults in general populations. The recommendation excludes pregnant women, children, and people with kidney impairment or other circumstances or conditions that might compromise potassium excretion.
  • Not stated as a care setting. The recommendation concerns table salt that a person adds to food while cooking or eating.
  • Global guideline; no country is specified
  • Adult; the guideline states no age bounds and excludes children
Follow-up Not applicable (recommendation context). The trials behind it followed adults from 56 days to 5 years.
Issued by
World Health Organization
Guideline
Use of lower-sodium salt substitutes: WHO guideline, edition Guideline dated 27 January 2025 on the WHO page; English PDF from WHO IRIS, both fetched 2026-10-11. The PDF title page shows only the year 2025.
Strength
Conditional recommendation (WHO guideline process with GRADE: strong or conditional. A conditional recommendation is one where the group is less certain that the desirable consequences outweigh the undesirable ones (footnote 6 of the executive summary). WHO describes the evidence as "moderate-to-low certainty (an assessment of low certainty overall ...)"; the atlas records low.)
Effective
2025-01-27 (Publication date shown on the WHO page. The PDF title page shows only the year 2025.)
Jurisdiction
Not tied to one country: a WHO global guideline. The document states no legal jurisdiction.
Basis
If adults in a general population choose to use table salt, WHO suggests replacing regular table salt with a lower-sodium salt substitute that contains potassium. This is a conditional recommendation, made alongside WHO's strong recommendation to keep sodium intake below 2 g a day. It is not intended for pregnant women, children, or people with kidney impairment or other conditions that might make it harder to clear potassium.

Limitations. WHO describes the evidence behind the recommendation as "moderate-to-low certainty (an assessment of low certainty overall ...)". The per-outcome levels are in WHO's Annex 6 GRADE table, which this record does not extract. It covers table salt that a person adds to food, not condiments such as soy sauce or sodium already in manufactured foods and restaurant meals. All trials in WHO's review excluded people who could be harmed by extra potassium and some also excluded people with diabetes, so evidence for those groups is uncertain. WHO says reducing sodium from all sources is the preferred strategy, and that a household member at risk of hyperkalaemia should not have food prepared with a substitute. It is recorded beside the NICE caution and does not resolve it.

Clinical links

Each link reports what one cited claim says about one population. "Evaluated for" means studied, not shown to work. These links do not show that anything is effective or right for you.

Record details

Record id
cardio:salt-substitution
Content hash
043dd285f13c1471eb0dc488f95a30876e032c98151230857d3d43c9ee35e04d