Replacement of regular salt with potassium-enriched substitutes reduces blood pressure in controlled situations, mainly among people with hypertension. We report on a population-wide implementation of this strategy in a stepped-wedge cluster randomized trial (NCT01960972). The regular salt in enrolled households was retrieved and replaced, free of charge, with a combination of 75% NaCl and 25% KCl. A total of 2,376 participants were enrolled in 6 villages in Tumbes, Peru. The fully adjusted intention-to-treat analysis showed an average reduction of 1.29 mm Hg (95% confidence interval (95% CI) (−2.17, −0.41)) in systolic and 0.76 mm Hg (95% CI (−1.39, −0.13)) in diastolic blood pressure. Among participants without hypertension at baseline, in the time- and cluster-adjusted model, the use of the salt substitute was associated with a 51% (95% CI (29%, 66%)) reduced risk of developing hypertension compared with the control group. In 24-h urine samples, there was no evidence of differences in sodium levels (mean difference 0.01; 95% CI (0.25, −0.23)), but potassium levels were higher at the end of the study than at baseline (mean difference 0.63; 95% CI (0.78, 0.47)). Our results support a case for implementing a pragmatic, population-wide, salt-substitution strategy for reducing blood pressure and hypertension incidence.

用富含钾的替代品代替普通盐可以在受控情况下降低血压，主要是高血压患者。我们在阶梯楔形整群随机试验 (NCT01960972) 中报告了该策略的全人群实施情况。登记家庭中的常规盐被免费取回并更换为 75% NaCl 和 25% KCl 的组合。秘鲁通贝斯的 6 个村庄共有 2,376 名参与者参加。完全调整后的意向治疗分析显示收缩压平均降低 1.29 mm Hg（95% CI（-1.39，- 0.13)) 舒张压。在基线时没有高血压的参与者中，在时间和集群调整模型中，盐替代品的使用与 51% (95% CI (29%, 66%)) 与对照组相比，患高血压的风险降低。在 24 小时尿液样本中，没有证据表明钠水平存在差异（平均差异 0.01；95% CI（0.25，-0.23）），但研究结束时钾水平高于基线（平均差异 0.63 ; 95% CI (0.78, 0.47))。我们的结果支持实施务实的、全人群的盐替代策略以降低血压和高血压发病率。