Two changes to what is on your plate lower blood pressure: eating less salt, and eating the DASH way, which means more vegetables, fruit, beans, nuts and low-fat dairy and less processed food. Each lowers pressure on its own, and doing both lowers it further, most of all in people who already have high blood pressure or whose pressure is salt-sensitive. In a trial of nearly 21,000 people in rural China, swapping ordinary table salt for a potassium salt substitute cut strokes, cardiovascular events and deaths over about five years.
Most people gain from both changes. The one place for care is potassium: a salt substitute can raise blood potassium too high in people with advanced kidney disease or on certain blood-pressure drugs, so check those first. To start, cook more from whole ingredients, lift potassium by eating more plants, and aim for a moderate intake instead of the lowest number you can reach.
Findings & Outcomes
What It Is
Two food changes work on the same problem. The first is eating less sodium. Most of it comes from processed and restaurant food, such as bread, processed meat, sauces, cheese and canned goods, and only a small share comes from the salt shaker. The second is the DASH pattern, short for Dietary Approaches to Stop Hypertension: a plate built on vegetables, fruit, beans, nuts, whole grains and low-fat dairy, lighter on red meat, sweets and saturated fat. That pattern is rich in potassium, which lowers blood pressure, the opposite of what sodium does. You can do either one on its own, and the largest effect comes from doing both.
What It Does
Eating less salt lowers blood pressure, and the effect is dependable. Across 34 trials, cutting salt by about a teaspoon a day lowered systolic pressure by about 4.2 mmHg overall, and by about 5.4 mmHg in people who already have high blood pressure, with a larger fall the more salt was cut. The DASH pattern lowers pressure again on top of that. In the feeding trial that tested the two together, DASH at a low sodium intake lowered systolic pressure by 8.9 mmHg against a typical high-salt diet, and by 11.5 mmHg in people with hypertension.
Potassium has the opposite effect. Raising it lowered pressure and went with about a quarter fewer strokes. The largest outcome trial tested the plainest version of this, swapping ordinary table salt for a potassium salt substitute, and cut strokes, cardiovascular events and deaths across nearly 21,000 people in rural China.
The evidence has two qualifications. When sodium drops very low, the body raises its salt-holding hormones and blood lipids edge up. And large studies that follow whole populations find worse outcomes at both very high and very low intakes. Together these point toward a moderate intake, not the lowest one you can reach. The findings, strongest first:
The Research & Studies
Everything here is based on the research we have collected and checked, sorted into groups and ordered with the strongest evidence first. Click any claim to open the studies behind it.
Heart And Vascular
The DASH diet lowered systolic pressure 5.5 mmHg without cutting salt, and 11.4 in people with high blood pressure
Eating the DASH way, lots of vegetables, fruit, beans, nuts and low-fat dairy and less processed food, lowered blood pressure over eight weeks even without changing salt or losing weight, and it worked best in people who already had high pressure.
Against a typical American control diet at the same sodium intake, the DASH diet lowered systolic blood pressure by 5.5 mmHg and diastolic by 3.0 mmHg over eight weeks, with a larger fall in people who began with hypertension (11.4/5.5 mmHg). Measured in: 459 adults with systolic pressure below 160 and diastolic 80 to 95 mmHg, roughly half women and about 60% Black, fed all meals for 11 weeks. This was a feeding study where every meal was provided, so it shows what the pattern does under full adherence, not how much benefit remains when people cook for themselves at home. It held sodium and body weight constant to isolate the dietary pattern.
The study · 1
Appel et al., a clinical trial of the effects of dietary patterns on blood pressure (DASH) · N Engl J Med 1997;336(16):1117-24
DASH plus low sodium cut systolic pressure 8.9 mmHg versus a high-salt typical diet, and 11.5 in people with hypertension
Doing both at once, eating the DASH way and cutting salt, lowered blood pressure more than either change alone, and the drop was biggest in people who started with high pressure.
The DASH diet at the lowest sodium level lowered systolic pressure by 8.9 mmHg compared with a control diet at high sodium, and by 11.5 mmHg in participants with hypertension. Within each diet, cutting sodium from high to low lowered pressure further, so the two effects added together. Measured in: 412 adults with systolic 120 to 159 and diastolic 80 to 95 mmHg, about 57% women and 57% Black, fed all meals across three sodium levels. A controlled feeding study over about a month at each sodium level, so it demonstrates the ceiling of the combined effect under full adherence rather than the effect at home. The lowest sodium arm was roughly 1.5 grams of sodium a day.
The study · 1
Sacks et al., effects on blood pressure of reduced dietary sodium and the DASH diet · N Engl J Med 2001;344(1):3-10
A potassium salt substitute cut stroke 14%, cardiovascular events 13%, and death 12%
In a large trial, families who used a potassium-based salt substitute instead of ordinary salt had fewer strokes, fewer heart attacks and strokes combined, and fewer deaths over about five years.
Replacing regular salt with a substitute of 75% sodium chloride and 25% potassium chloride lowered the rate of stroke by 14% (RR 0.86), major cardiovascular events by 13% (RR 0.87), and death from any cause by 12% (RR 0.88) over a mean 4.7 years. Measured in: 20,995 adults in 600 rural Chinese villages, about 49% women, all with prior stroke or aged 60-plus with high blood pressure. The participants were older with a history of stroke or hypertension, so the absolute benefit is largest in high-risk groups and cannot be assumed identical in a young, low-risk person. The trial deliberately excluded people at risk of high potassium.
The study · 1
Neal et al., effect of salt substitution on cardiovascular events and death (SSaSS) · N Engl J Med 2021;385(12):1067-1077
Cutting about a teaspoon of salt a day lowered systolic pressure 4.2 mmHg, and 5.4 in people with high blood pressure
Cutting salt by about a teaspoon a day lowered blood pressure across dozens of trials, roughly twice as much in people who already had high pressure as in those who did not.
A modest cut in salt of about 4.4 grams a day lowered systolic pressure by about 4.2 mmHg overall, about 5.4 mmHg in people with hypertension, and about 2.4 mmHg in those without, with a larger fall the greater the reduction in salt. Measured in: 34 randomized trials of at least four weeks, pooling 3,230 adults. The trials lasted weeks to a few months, so they measure the blood-pressure response rather than the long-term outcome, and salt intake was reduced by more than most people achieve unaided.
The study · 1
He et al., effect of longer term modest salt reduction on blood pressure, Cochrane meta-analysis · BMJ 2013;346:f1325
Every 100 mmol less sodium a day, about 2.3 g, lowered systolic pressure 5.6 mmHg, and 6.5 in people with high blood pressure
The more salt people cut, the more their blood pressure dropped, in a steady step-by-step way with no point where cutting further stopped helping. For each teaspoon or so of salt cut a day, the top blood pressure number fell by about 5 to 6 points, and more in people who already had high pressure.
Across 85 randomized trials with sodium intake from 0.4 to 7.6 grams a day, blood pressure fell in step with how much sodium was cut, with no floor within that range. For every 100 mmol of sodium cut per day, about 2.3 grams or roughly a teaspoon of salt, systolic pressure fell about 5.6 mmHg, and about 6.5 mmHg in people with high blood pressure against about 2.3 in those without. The relationship was close to linear and steeper at higher starting pressure. Measured in: 85 randomized trials pooled in a dose-response meta-analysis. Most contributing trials were short, so this describes the pressure response to a change in intake, not the net effect on disease, which other designs address.
The study · 1
Filippini et al., blood pressure effects of sodium reduction, dose-response meta-analysis · Circulation 2021;143(16):1542-1567
The higher the starting pressure, the bigger the drop: about 5 mmHg near normal, about 21 at 150 and above
The higher your blood pressure to begin with, the more this diet lowered it: a small drop for people near normal, and a large one for people whose pressure was already high.
In a secondary analysis of the DASH-Sodium trial, the blood-pressure fall from combining the DASH diet with low sodium grew with baseline pressure: about 5 mmHg systolic in those starting below 130, rising to about 21 mmHg in those starting at 150 or above. Measured in: The 412 DASH-Sodium participants, grouped by baseline systolic pressure. The highest-pressure subgroups were small, so the 21 mmHg figure carries wider uncertainty than the average effect, and regression to the mean inflates apparent change in the highest-starting group.
The study · 1
Juraschek et al., effects of sodium reduction and the DASH diet in relation to baseline blood pressure · J Am Coll Cardiol 2017;70(23):2841-2848
Lower sodium intake tracked with fewer strokes and fewer fatal heart attacks
Across the evidence, eating less salt lowered blood pressure and went with fewer strokes and fewer deaths from heart disease.
Lower sodium intake reduced blood pressure in adults and was associated with lower risk of stroke and fatal coronary heart disease, with no adverse effect on blood lipids or catecholamines at the intakes examined in the outcome analyzes. Measured in: A WHO-commissioned review pooling controlled trials and cohort studies of adults and children. The disease-outcome part rests partly on observational data, and the review pooled trials of differing quality and duration, so the size of the outcome benefit is less certain than the blood-pressure effect.
The study · 1
Aburto et al., effect of lower sodium intake on health, systematic review and meta-analyzes · BMJ 2013;346:f1326
More potassium lowered systolic pressure 3.5 mmHg and tracked with 24% fewer strokes
Eating more potassium, the mineral plants are rich in, lowered blood pressure, mostly in people who already had high pressure, and went with a lower risk of stroke.
Raising potassium intake lowered systolic pressure by about 3.5 mmHg in adults overall, an effect seen in people with high blood pressure but not in those without, and was associated with a 24% lower risk of stroke. Measured in: Randomized trials and cohort studies of adults pooled in a WHO-commissioned review. The stroke figure comes from cohort data and carries the usual confounding of dietary observation, since high-potassium eaters differ in many ways. The blood-pressure effect was minimal in people who were not hypertensive.
The study · 1
Aburto et al., effect of increased potassium intake on cardiovascular risk factors and disease · BMJ 2013;346:f1378
Potassium lowered blood pressure most at moderate intake and in high-salt eaters, in a U-shaped dose-response
Adding potassium lowered blood pressure up to a point, and it helped most in people eating a lot of salt, which suggests the balance between the two minerals matters more than either by itself.
Blood pressure fell as potassium intake rose, but the benefit weakened once the daily increase passed about 30 mmol and pressure edged back up above about 80 mmol, a U-shaped relationship. The fall was greatest in people with high blood pressure and those whose sodium intake was high, pointing to the sodium-to-potassium balance rather than either mineral alone. Measured in: 32 randomized controlled trials pooled in a dose-response meta-analysis. Contributing trials were mostly short-term and used potassium supplements rather than food, so the figure describes supplemental potassium and may not map exactly onto potassium eaten as vegetables and fruit.
The study · 1
Filippini et al., potassium intake and blood pressure, dose-response meta-analysis · J Am Heart Assoc 2020;9(12):e015719
People who cut salt in a trial had 25 to 30% fewer cardiovascular events 10 to 15 years later
People who had taken part in salt-cutting programs had fewer heart attacks and strokes 10 to 15 years later than those who had not.
In long-term follow-up of two sodium-reduction trials, people randomized to the sodium-reduction programs had 25 to 30% lower risk of a cardiovascular event 10 to 15 years later than those who were not. Measured in: 2,415 adults with high-normal blood pressure from the Trials of Hypertension Prevention, followed observationally after the trials ended. What could explain it instead: After the trials ended, the groups were no longer kept on their assigned diets, so differences in later lifestyle, weight and medical care could contribute to the outcome gap rather than the original sodium reduction alone.. The original assignment was randomized, but the long-term outcome tracking was observational after the intervention ended, so later differences in behavior between the groups cannot be fully ruled out. The event count over follow-up was modest.
The study · 1
Cook et al., long term effects of dietary sodium reduction on cardiovascular disease outcomes (TOHP) · BMJ 2007;334(7599):885
Both high sodium (above 7 g) and low (below 3 g) tracked with more deaths than a middle intake
In a study following people across many countries, both very high and very low salt intake went with worse outcomes than a middle amount. The low-salt end is hard to trust because sick people often already eat less salt, and intake was estimated from a single urine sample.
In a large international cohort, both high estimated sodium intake (above about 7 grams a day) and low intake (below about 3 grams a day) were associated with higher death and cardiovascular events than a middle range, forming a J-shaped curve rather than a straight line. Measured in: 101,945 adults across 17 countries in the PURE study, followed a mean of 3.7 years. What could explain it instead: People with low measured sodium include those already sick or frail who have cut back, and single-sample estimation misclassifies intake, so the apparent harm at low sodium may reflect illness and measurement error rather than the salt itself.. Sodium was estimated from a single morning urine sample, which is an imprecise measure of habitual intake, and reverse causation is a live concern because people already ill often eat less salt, which can create an apparent risk at low intake.
The study · 1
O'Donnell et al., urinary sodium and potassium excretion, mortality, and cardiovascular events (PURE) · N Engl J Med 2014;371(7):612-23
How it works
Very low sodium raised renin, aldosterone and stress hormones, with small rises in cholesterol and triglycerides
When sodium goes very low, the body raises its stress and salt-holding hormones, and cholesterol and triglycerides edge up a little. It is one reason a moderate cut is better than chasing the lowest possible intake.
Cutting sodium lowered blood pressure but also raised renin, aldosterone, adrenaline and noradrenaline, and produced small rises in total cholesterol of about 5.2 mg/dL (0.13 mmol/L) and in triglycerides of about 7.1 mg/dL (0.08 mmol/L), with the hormonal rises largest at the lowest intakes. Measured in: 195 randomized studies pooled in a Cochrane review of low versus high sodium diets. These are short-term biochemical responses whose long-term clinical meaning is contested, and the lipid changes were small and drawn largely from very-low-sodium arms, so they weigh most against chasing an extreme rather than against moderate reduction.
The study · 1
Graudal et al., effects of low sodium diet versus high sodium diet on blood pressure, renin, aldosterone, catecholamines, cholesterol, and triglyceride · Cochrane Database Syst Rev 2020;12(12):CD004022
How It Works
Sodium holds water. Eat more of it and the body keeps more fluid in the bloodstream to hold the salt concentration steady, which raises the volume and the pressure inside the vessels, and over years the small arteries stiffen in response. Cutting sodium reverses part of that. It helps some people more than others. People whose pressure rises and falls sharply with salt intake are called salt-sensitive, and they are more often older and more often of African or East Asian ancestry, because their vessels and kidneys hold onto sodium more readily. They have the most to gain from eating less of it.
Potassium has the opposite effect. It helps the kidney release sodium and relaxes the vessel walls, so raising potassium while lowering sodium lowers blood pressure through two separate mechanisms. This is why the DASH pattern, rich in plants, does more than salt reduction alone, and why a potassium-based salt substitute lowers pressure: it lowers sodium and adds potassium in a single swap. Potassium helps up to a point. Above a moderate daily amount the added benefit fades, and at high intakes pressure can edge back up, so the balance between the two minerals matters more than the amount of either one alone.
A potassium salt substitute is a hazard for a few people. In advanced kidney disease, or while taking a potassium-sparing blood-pressure drug, it can raise blood potassium to a dangerous level. Check kidney function and potassium first.
When sodium drops very low, the body raises renin and aldosterone, the hormones that signal the kidney to hold onto sodium, and pooled trials find small rises in cholesterol and triglycerides at the lowest intakes. Separately, large studies that follow whole populations find that both very high and very low sodium go with worse outcomes, a J-shaped curve. Those studies observe people rather than assign a diet, and people who eat very little salt are often those who cut back because they are already unwell, so reverse causation can create the appearance of harm at the low end. Read together, the evidence points to a moderate target: bring a high intake down toward a moderate one, and raise potassium by eating more plants.
Ways to Do It
You can start today for nothing, and the more convenient routes mostly save you cooking time. Change one thing at a time so your taste can adjust, which takes a week or two. Read labels in milligrams of sodium, because how salty a food tastes is a poor guide: bread and breakfast cereal carry more sodium than their taste suggests. If you have kidney disease or take a blood-pressure drug, read the Cautions below before you use a salt substitute.
Most sodium comes from processed and restaurant food, so cooking from whole ingredients is the single change that does the most, and it costs nothing. Build meals on vegetables, fruit, beans, whole grains and nuts, which is the DASH pattern and raises potassium at the same time. Season with herbs, garlic, citrus, vinegar and spice, and taste before you add salt.
Swapping ordinary salt for a substitute that is part sodium chloride, part potassium chloride cuts sodium and adds potassium with one change, and it is the exact swap that cut strokes and deaths in the largest trial. It costs a little more than table salt and needs no new habits. Skip it if you have advanced kidney disease or take a potassium-sparing drug, for the reason in the Cautions.
If you would like to see where you stand, you can buy your own blood-pressure cuff and, through direct-to-consumer testing services, order a kidney panel and electrolytes without waiting for a referral. That shows your potassium and kidney function before you start a substitute, and lets you watch your own pressure respond over a few weeks.
Go Deeper
- Hypertension: the condition these two food changes address, with the full set of options and how to measure your pressure properly.
- Whole foods: the shift toward home cooking and away from processed food that carries most of the sodium benefit.
- Resistance training: the movement side of the same cardiovascular picture, and one of the best-supported things you can do for it.
The Chinese Medicine View
Chinese medicine reads salt as the salty flavor (咸味), which enters the Kidney and is used to soften hardness and guide action downward. In small, correct amounts the salty flavor supports the Kidney, and salt is used deliberately in the tradition, for instance to fry herbs so their action is directed toward the Kidney. The tradition does not hold that salt is simply bad.
On excess, the classics are direct. The Su Wen warns that when the flavors are eaten to excess, too much salt makes the pulse congeal and change (多食咸，則脈凝泣而變色), and that overindulging the salty flavor taxes the large bones, wastes the flesh, and oppresses the Heart Qi. Taken as description, this links heavy salt to the vessels and the Heart, which fits the modern picture. Taken as mechanism, it is a different language from sodium, fluid volume and vascular tone, and the two accounts describe the same body without translating into one another.
This lens does not apply one rule to everyone. The tradition does not read the same diet as right for every person or every season. Someone with clear signs of internal heat, a red face, a wiry pulse, thirst and constipation, fits the cooling, plant-heavy DASH pattern well. Someone who runs cold and depleted, a Yang or Kidney Yang deficiency with cold limbs, loose stools and low energy, does better with warmth and a gentler adjustment than with the lowest possible sodium. If you work with a practitioner, your pattern is a good thing to ask about, because the right version of this depends on who you are.
Cautions For This Practice
Everything to be aware of is here, in one place. This practice suits most healthy people; a few situations call for real care.
The salt substitute did not raise serious high-potassium events (risk ratio 1.04)
The same trial found no significant increase in serious clinical hyperkalemia with the salt substitute compared with regular salt (RR 1.04), in a population screened to exclude those already at risk of high potassium. Reassurance about potassium applies to the population studied, which specifically screened out advanced kidney disease and potassium-sparing drugs. It does not extend to those excluded groups, for whom that risk remains.Neal et al., effect of salt substitution on cardiovascular events and death (SSaSS)
Salt substitutes and potassium: the main hazard
Potassium salt substitutes replace some sodium with potassium chloride. In most people the kidney clears the extra potassium easily, and the large salt-substitute trial found no rise in serious high-potassium events, but that trial screened out people with serious kidney disease and anyone taking a potassium-sparing diuretic. If you have advanced kidney disease, or you take a potassium-sparing drug such as spironolactone, amiloride or eplerenone, or an ACE inhibitor or ARB where your potassium is already watched, a substitute can raise blood potassium to a level that disturbs the heart rhythm. Check your kidney function and potassium first, and use ordinary sodium reduction instead of a substitute if either is a concern.
Aim for moderate, not the lowest possible number
The clearest gains come from bringing a high sodium intake down toward a moderate one. At very low intakes, pooled trials show the body raising renin and aldosterone and small rises in cholesterol and triglycerides, and population studies find worse outcomes at both extremes. There is no need to chase the lowest number you can reach.
If your fluid or salt balance is medically managed
People on diuretics, being treated for heart failure, or living with conditions that waste salt should change sodium alongside whoever manages that treatment, since sodium, potassium and fluid are being balanced together. Endurance athletes and people who sweat heavily in heat lose considerable sodium and should account for that before restricting.
Go gradually and educate yourself
Taste adjusts to less salt over a week or two, so step it down instead of cutting all at once, and read labels in milligrams, since the saltiest foods are often not the ones that taste saltiest. If you have questions, or a condition that touches on blood pressure, kidneys or the heart, a licensed practitioner is worth a conversation.
Start slow, be smart, read the research, and consult a professional if you have any concerns. This is here to inform your choice, not make it for you.
Common Questions
Is it better to cut salt or to change my whole diet?
Both, and together they do the most. Cutting sodium lowers blood pressure on its own, and the DASH pattern of more plants and less processed food lowers it on its own, partly because it is high in potassium. In the DASH-Sodium feeding trial that tested them together, the combination lowered systolic pressure by 8.9 mmHg against a typical high-salt diet, more than either change alone, and the drop was largest in people who already had high pressure.
Who gets the most out of eating less salt?
People whose pressure is salt-sensitive, which more often means older adults and people of African or East Asian ancestry, and anyone who already has high blood pressure. In the pooled trials, a modest cut in salt lowered systolic pressure about 5.4 mmHg in people with hypertension against about 2.4 in those without, so the benefit is roughly twice as large when pressure is already high, and it grows with how high the starting pressure is.
Do salt substitutes really work, or is that marketing?
They work. In the SSaSS trial of nearly 21,000 people in rural China, swapping ordinary salt for a part-potassium substitute cut the rate of stroke by 14%, major cardiovascular events by 13%, and death by 12% over about five years. The catch is potassium: the same substitute is a hazard for people with advanced kidney disease or on certain blood-pressure drugs, covered in the Cautions above.
How much less sodium should I actually aim for?
Most guidance points toward moving a high intake down toward one and a half to two grams of sodium a day, which is roughly a teaspoon or less of salt in total, most of it already hidden in packaged food. The evidence is strongest for bringing a high intake down to a moderate one. Below about three grams a day the population data get murky, and the body starts raising its salt-holding hormones, so there is little reason to chase the lowest number.
Explore Related
Other pages this one connects to, by the evidence they share, the outcomes they touch, and the ground they cover.
All 13 sources on this page independently checked and cross-referenced.
Thomas Dehli, Founder & Editor, Sacred Lotus
Sacred Lotus has published Chinese medicine reference material since 2001. Integrative pages are held to the same standard as the herb and formula library: cite the source, grade the claim at its real strength, and say where the research has not looked. This page is educational and it is not medical advice. Last reviewed and updated August 9, 2026.
Evidence strength
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