Changing what goes into the world’s salt supply could prevent almost 3 million deaths each year, a global modeling study estimates. Replacing some sodium chloride with potassium chloride would address two dietary problems linked to high blood pressure. The projected gains extend to both cardiovascular disease and chronic kidney disease. Achieving them, however, would require a sustained transformation of food production and household habits.

Researchers at The George Institute for Global Health examined five possible strategies across 193 countries. Their findings, published in Nature Health, combine evidence about diet, blood pressure and disease risk. The headline estimate assumes widespread replacement of salt in home cooking, manufactured foods and restaurant meals. It describes the potential of salt substitution, rather than deaths already prevented by a global program.

Regular table salt consists of sodium chloride. The researchers modeled a substitute containing 75% sodium chloride and 25% potassium chloride by weight. Using that blend instead of the same quantity of regular salt would reduce sodium intake while adding potassium. Its appeal is that people could change the product they use without abandoning familiar cooking routines.

Too much sodium and too little potassium contribute to elevated blood pressure. Lowering pressure can reduce risks including stroke, heart disease and kidney disease. The model translated changes in mineral intake into changes in systolic pressure, the upper number in a blood-pressure reading. It then estimated the resulting differences in disease and deaths.

Bruce Neal, a senior professorial fellow at The George Institute, emphasized the combined dietary effect. “Switching to potassium-enriched salt addresses both these dietary issues at the same time, with substantial health benefits,” he said. The model evaluates that approach across populations with different diets and disease burdens. Its results suggest that the opportunity extends beyond patients already receiving treatment.

The approach builds on clinical evidence, including the Salt Substitute and Stroke Study reported in the New England Journal of Medicine. That trial enrolled 20,995 people in 600 Chinese villages and found fewer strokes, major cardiovascular events and deaths with the substitute. Participants had previous stroke or were older adults with high blood pressure. Those results support the intervention, but they are not a direct test of nationwide replacement in every population.

Replacing both household and commercially supplied salt could avert an estimated 2.96 million deaths annually. The model’s 95% uncertainty interval ranged from 2.81 million to 3.12 million. It also projected 10.17 million fewer new cardiovascular and chronic kidney disease cases each year. These are estimates under the modeled conditions, not a forecast that implementation will immediately produce those totals.

The projected deaths prevented equal 14.6% of annual deaths from the two disease groups combined. In 133 of the 193 countries, the full switch could prevent at least 10% of cardiovascular deaths. China and India showed the largest absolute gains because of their population sizes and dietary exposure. Benefits were therefore widespread, although their magnitude varied between countries.

The death estimates already account for potential harm from excessive blood potassium among people with kidney disease. Researchers subtracted those modeled deaths from deaths prevented through lower blood pressure. This distinction matters when interpreting the headline total. It is a projected net benefit, rather than a calculation that ignores the intervention’s main safety concern.

Switching only salt used in home cooking and seasoning could prevent about 1.85 million deaths annually. Replacing only salt in processed foods and restaurant meals produced an estimate of 1.56 million. Those separate figures should not be added together to recreate the full-switch total. The strategies affect overlapping disease risks, and the model calculates their combined effects separately.

Which strategy makes most sense depends on where a country’s sodium comes from. Globally, household-added salt accounts for a large share, making home use an important target. In Europe and the United States, more than 70% comes from processed and restaurant foods. Changing the household saltshaker alone would therefore leave much of that exposure untouched.

More targeted programs could also deliver substantial benefits. Replacing household salt among people with diagnosed hypertension could avert about 590,000 deaths annually, the model estimated. Limiting the strategy to people treated for hypertension produced an estimate of 480,000. These scenarios assumed that 20% would be advised against using the substitute because of possible kidney disease or potassium-related risk.

Potassium-enriched salt is not suitable for everyone. People with impaired kidney function can struggle to remove excess potassium, allowing dangerous levels to accumulate in the blood. This condition, hyperkalemia, is particularly concerning in advanced kidney disease. Certain medications can also increase the risk, making clinical assessment essential.

Among people with stage 3–5 chronic kidney disease, the model projected approximately 750,000 cardiovascular deaths prevented through blood-pressure reduction. It also estimated around 100,000 deaths potentially caused by hyperkalemia under full replacement. The balance favored benefit across that population. It does not establish that an individual patient should switch without medical advice.

“People with serious kidney disease and those taking medications that significantly raise blood potassium levels need to take precautions,” said nephrologist Vivek Jha. “Risks for this group can be managed effectively through patient education, product labelling, and clinical oversight.” Jha is a senior professorial fellow at The George Institute in India. The study also highlights screening and clearer potassium information on packaging as safeguards for people with reduced kidney function.

WHO’s conditional recommendation concerns adults choosing to use table salt. It excludes people with kidney impairment or other conditions that compromise potassium excretion, and does not apply to children or pregnant women. Its scope also differs from the paper’s broader scenario covering manufactured foods. The modeling findings should not be read as removing those exclusions.

Implementation would require affordable products, reliable supplies and participation from the food industry. Potassium chloride production would need to expand to support widespread replacement. Governments would also need labeling rules and safeguards alongside efforts to encourage uptake. The researchers expect a full transition to take many years, potentially decades. The paper reports that potassium-enriched salt costs about twice as much as regular salt on average. Lower prices would be important for wider adoption, particularly where household budgets are tight.

The estimates also depend on assumptions that cannot capture every country’s circumstances. Dietary data are several years old, and information separating household from commercial salt sources is limited. Relationships between mineral intake and blood pressure vary, including with existing hypertension care. Alternative assumptions reduced projected benefits, although substantial gains remained in the analyses tested.

The study offers countries a framework for choosing realistic priorities. A household-focused program may suit one setting, while another needs reformulation of widely consumed foods. Both require attention to people who cannot safely increase potassium. The potential lies in changing a common ingredient at scale while making its benefits accessible and its risks visible.

These resources explain the clinical evidence, remaining uncertainties and guidance for safer use.

Research findings are available online in the journal Nature Health.