Potassium

Do salt substitutes with potassium lower the risk of stroke?

Updated 9 Nov 2026

Short answer

In one large trial, yes. The trial followed 20,995 people in rural China who had had a stroke, or were 60 or older with high blood pressure. A salt with 25% potassium chloride lowered their stroke rate by 14% over about 4.7 years.[1] A 2022 Cochrane review rates the effect on non-fatal stroke and cardiovascular deaths as slight, with moderate certainty.[2]

The largest trial

The Salt Substitute and Stroke Study (SSaSS) included 20,995 people from 600 villages in rural China. Their mean age was 65.4 years, 72.6% had had a stroke, and 88.4% had high blood pressure.[1] The villages were assigned by chance to a salt substitute (75% sodium chloride and 25% potassium chloride) or to regular salt.[1]

After a mean of 4.74 years, the rates per 1,000 person-years (1,000 people followed for one year) were:

  • stroke: 29.14 with the salt substitute and 33.65 with regular salt, a rate ratio of 0.86[1]
  • major cardiovascular events: 49.09 and 56.29, a rate ratio of 0.87[1]
  • death from any cause: 39.28 and 44.61, a rate ratio of 0.88[1]
  • serious events from high blood potassium: 3.35 and 3.30, not a significant difference[1]

What the Cochrane review found

A 2022 Cochrane review pooled 26 trials with 34,961 adults.[2] Compared with regular salt, salt substitutes probably lower non-fatal stroke slightly, by about 20 cases per 100,000 person-years. They probably lower cardiovascular deaths slightly, by about 180 per 100,000 person-years.[2] They probably also lowered systolic blood pressure by 4.76 mmHg and diastolic pressure by 2.43 mmHg.[2] They probably raise blood potassium slightly, by 0.12 mmol/L, and may make little to no difference to hyperkalemia.[2]

What cohort studies show

Cohort studies follow people for years and compare those who eat more potassium with those who eat less. In a 2016 review of 16 cohort studies, people with the highest intake had a 13% lower risk of stroke than people with the lowest, after taking blood pressure into account.[3] The risk was lowest at about 90 mmol (about 3,500 mg) a day.[3] A 2013 review found a 24% lower risk of stroke with higher intake, but no significant link with coronary heart disease or cardiovascular disease as a whole.[4]

WHO recommends more potassium from food to lower blood pressure and the risk of cardiovascular disease, stroke and coronary heart disease in adults. It suggests at least 3,510 mg (90 mmol) a day.[5] The US FDA allows a health claim for these diets. It says that diets with foods rich in potassium and low in sodium may reduce the risk of high blood pressure and stroke.[6]

Who should be careful

All 26 trials in the Cochrane review left out people for whom more potassium is known to be harmful.[2] One teaspoon of salt substitute can contain 440 to 2,800 mg of potassium.[6] People with kidney disease, or who take some medicines, should ask a doctor before they use a salt substitute, because of the risk of hyperkalemia.[6]

What is still unknown

The Cochrane authors say that evidence is limited for adults without high blood pressure, and that no trial included pregnant women.[2] They could not draw firm conclusions about safety in the general population.[2]

Sources (6)

  1. Effect of Salt Substitution on Cardiovascular Events and Death. Neal B, Wu Y, Feng X, Zhang R, Zhang Y, Shi J, et al. N Engl J Med, 2021. PMID 34459569
  2. Replacing salt with low-sodium salt substitutes (LSSS) for cardiovascular health in adults, children and pregnant women. Brand A, Visser ME, Schoonees A, Naude CE Cochrane Database Syst Rev, 2022. PMID 35944931
  3. Meta-Analysis of Potassium Intake and the Risk of Stroke. Vinceti M, Filippini T, Crippa A, de Sesmaisons A, Wise LA, Orsini N J Am Heart Assoc, 2016. PMID 27792643
  4. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP BMJ, 2013. PMID 23558164
  5. Guideline: Potassium intake for adults and children. World Health Organization, 2012. iris.who.int
  6. Potassium: Fact Sheet for Health Professionals. NIH Office of Dietary Supplements. ods.od.nih.gov

More about potassium

What is potassium?Which foods contain potassium?What is potassium used for?What happens if you do not get enough potassium?Is potassium safe?Why do potassium supplements contain only 99 mg?

For education; not medical advice. Talk to a doctor before you start, stop or change a supplement.