Trial reportNature medicine2023
Salt substitution and salt-supply restriction for lowering blood pressure in elderly care facilities: a cluster-randomized trial.
Trial report in Nature medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03290716 (Diet, Exercise and Cardiovascular Health - Effect of Salt Substitute and Stepwise Salt Supply Control in Reducing Blood Pressure in the Elderly in Nursing Homes in China), which is not on this map. Cited by 50 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Diet, Exercise and Cardiovascular Health - Effect of Salt Substitute and Stepwise Salt Supply Control in Reducing Blood Pressure in the Elderly in Nursing Homes in China: a Factorial Cluster-randomized Controlled Trial
Who cites it
50 citing papers in PubMed, 4 syntheses or guidelines pooled it, 94 citations in OpenAlex.
- Pooled it
- Comparative effects of salt substitutes on blood pressure, cardiovascular events and mortality: a systematic review and network meta-analysis.BMC medicine · 2026Pooled it
- Effect of population-based sodium reduction interventions on blood pressure: a systematic review and meta-analysis of randomized trials.Hypertension research : official journal of the Japanese Society of Hypertension · 2025Pooled it
- Systematic Review of Social Marketing as a Behavior Change Agent in Salt Reduction.Global heart · 2025Pooled it
- Effects of salt substitution on cumulative blood pressure: a secondary analysis of the SSaSS.European journal of epidemiology · 2025Trial
- Long-Term Effects of a Comprehensive Intervention Strategy for Salt Reduction in China: Scale-Up of a Cluster Randomized Controlled Trial.Nutrients · 2024Trial
- Cost-Effectiveness of Salt Substitute and Salt Supply Restriction in Eldercare Facilities: The DECIDE-Salt Cluster Randomized Clinical Trial.JAMA network open · 2024Trial
- Trial
- The kidney distal tubule potassium switch, modern diet and hypertension.Nature reviews. Nephrology · 2026Review
- [Potassium substitution: is replacing sodium with potassium-enriched salts beneficial?]Innere Medizin (Heidelberg, Germany) · 2026Review
- Cardiovascular Health Promotion and Disease Prevention in China: Calling for New-Era Strategies.JACC. Asia · 2026Review
- Blood Pressure Reduction Effects of Salt Substitutes in Different Application Settings A Meta-Analysis of Randomized Controlled Trials.JACC. Asia · 2026Article
- Universal Adoption of Salt-Substitution Matters for Blood Pressure Control: Collective Implementation, Greater Impact.JACC. Asia · 2026Article
- Pathophysiological Mechanisms and Clinical Controversies of Sodium-Induced Hypertension: A Multi-Systemic Perspective.Nutrients · 2026Review
- Lower-sodium, potassium-enriched salt substitution: An opportunity for improving blood pressure in Jamaica?Public health in practice (Oxford, England) · 2026Article
- Potassium and the kidney.Nature reviews. Nephrology · 2026Review
- How Does Dietary Potassium Influence BP?Journal of the American Society of Nephrology : JASN · 2026Review
- Impact of Community-Based Hypertension Screening on Blood Pressure Management and the Role of Socioeconomic Status.Journal of the American Heart Association · 2026Article
- Implications of the 2025 AHA/ACC high blood pressure guidelines on the initiation and intensification of blood pressure-lowering medications among US adults.American journal of preventive cardiology · 2026Article
- Piezo1 dictates KProceedings of the National Academy of Sciences of the United States of America · 2026Article
Corrections and comments
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Authors and funding
27 authors at 9 institutions in 4 countries.
Funding
Abstract
There is a paucity of high-quality evidence on the effectiveness and safety of salt reduction strategies, particularly for older people, who have the most to benefit but are at higher risk of adverse effects. Here, we conducted a clinical trial in which 48 residential elderly care facilities in China (1,612 participants including 1,230 men and 382 women, 55 years or older) were cluster-randomized using a 2 × 2 factorial design to provision of salt substitute (62.5% NaCl and 25% KCl) versus usual salt and to a progressively restricted versus usual supply of salt or salt substitute for 2 years. Salt substitute compared with usual salt lowered systolic blood pressure (-7.1 mmHg, 95% confidence interval (CI) -10.5 to -3.8), meeting the primary outcome of the trial, whereas restricted supply compared with usual supply of salt or salt substitute had no effect on systolic blood pressure. Salt substitute also lowered diastolic blood pressure (-1.9 mmHg, 95% CI -3.6 to -0.2) and resulted in fewer cardiovascular events (hazard ratio (HR) 0.60, 95% CI 0.38-0.96), but had no effect on total mortality (HR 0.84, 95% CI 0.63-1.13). From a safety standpoint, salt substitute increased mean serum potassium and led to more frequent biochemical hyperkalemia, but was not associated with adverse clinical outcomes. In contrast, salt restriction had no effect on any study outcome. The results of this trial indicate that use of salt substitute, but not efforts to restrict salt supply, may achieve blood pressure lowering and deliver health benefits to residents of elderly care facilities in China. Clinicaltrials.gov registration: NCT03290716.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.