Scaling Sodium Reduction Solutions

Hypertension, or high blood pressure, is the most common modifiable risk factor for the development of cardiovascular diseases, such as heart failure and coronary artery disease. It is also known to increase risk of stroke, dementia, chronic kidney disease, and mortality from any cause (Jones et al. 2025). Many guidelines recommend limiting salt intake to reduce the incidence of hypertension and thereby reduce the risk of associated diseases.

Although the terms salt and sodium are often used interchangeably, table salt is actually composed of approximately 40% sodium and 60% chloride by weight (He et al. 2020). Thus, 5 g of salt contains around 2,000 mg of sodium. For clarity, this article keeps the two terms distinct.

The American Heart Association (AHA) defines hypertension as a systolic blood pressure over 130 mmHg and/or a diastolic blood pressure of over 80 mmHg (Jones et al. 2025). The causes of hypertension are multifactorial, with genetics, lifestyle choices, and environmental exposures all playing a role. Among these contributing factors, high salt intake has consistently been shown to result in a corresponding rise in blood pressure with a dose-dependent response (He et al. 2020). Based on this evidence, the AHA and numerous other national organizations recommend that people consume no more than 2,300 mg of sodium per day, ideally no more than 1,500 mg per day for individuals with known hypertension or other cardiovascular risk factors (Jones et al. 2025). Despite these recommendations, current estimates suggest an average daily sodium intake of 4,000 mg worldwide (Thout et al. 2019).

Sodium likely contributes to blood pressure via the renin-angiotensin-aldosterone system (RAAS) and regulation of extracellular fluid volume, although the exact mechanisms have not been fully elucidated (He et al. 2020, Nishimoto et al. 2024, Kong et al. 2025). Excess sodium intake appears to impair the body’s ability to suppress the RAAS, leading to increased sodium and fluid reabsorption in the kidneys. Moreover, as kidney function deteriorates with age, so too does its ability to secrete excess sodium in the urine, leading to increased sodium and fluid retention, which in turn leads to higher blood pressure (He et al. 2020, Nishimoto et al. 2024). Of course, this is an oversimplification of a complex process, but it demonstrates that there is a physiological explanation for the effects of salt intake on blood pressure.

As previously mentioned, hypertension is a known risk factor for the development of cardiovascular disease and stroke. It would seem to follow that a diet high in salt would therefore also increase risk of such diseases. This was illustrated in a 2021 study that compared the effects of using a salt substitute (75% sodium chloride and 25% potassium chloride by weight) with use of traditional table salt on stroke, adverse cardiovascular events, and all-cause mortality (Neal et al. 2021). The study was conducted throughout 600 villages in rural China and included 20,995 participants who either had a history of stroke or were age 60 or older with hypertension. Utilization of the salt substitute was associated with a significantly lower risk of stroke, other cardiovascular events, and death from any cause (Neal et al. 2021).

Whether this study could be conducted in America or other countries with similar results seems unlikely. Whereas the residents of the rural villages in the study almost exclusively ate food that was prepared and cooked at home, Americans obtain most of their sodium from processed foods and food prepared outside the home (Lichtenstein et al. 2021).

The U.S. food industry has made measurable progress in sodium reduction in response to a stepwise reformulation initiative introduced by the U.S. Food and Drug Administration (FDA). Guidance issued by the FDA in 2021 proposed sodium targets for 16 food categories and 163 subcategories, and by 2022, about 40% of the targets had been reached. Additional sodium reduction targets were announced in 2024 in a second phase of the initiative (Covington 2024). Taken together, these targets are projected to decrease sodium intake in the United States by about 20% from previous levels (FDA 2024).

Many food product formulators have turned to sodium chloride/potassium chloride blends to achieve sodium reduction, although the amount of potassium chloride that can be used without affecting taste profiles varies by product.

Salt is here to stay. But through a combination of moderation and food science, we can reduce the risks associated with its intake.