Abstract
The relationship between the differential protective effect of salt substitute between hypertensive and normotensive individuals and the use of cardiovascular medications remains unclear. This study involved 4211 individuals with a history of stroke or hypertension who participated in the Salt Substitute and Stroke Study (SSaSS) from 120 villages in Shanxi Province. The aim of this study was to investigate the differences in major adverse cardiovascular events and blood pressure changes between the salt substitute and the regular salt group in the subgroups of participants taking different antihypertensive medications. Mixed models were employed and adjusted for the cluster effect (village) and potential confounding variables. During the average follow‐up period of 4.66 years, a significantly protective effect of salt substitute on reducing the risk of cardiovascular events was observed in the participants who taking antihypertensive medications (rate ratio: 0.81, 95% CI: 0.68 to 0.95. p = 0.011), whereas no significant effect in participants not taking antihypertensive medications (rate ratio: 0.91, 95% CI: 0.62 to 1.32, p = 0.612). Significant effects to lower systolic blood pressure of the salt substitutes were observed in the participants who took different antihypertensive medications. This study emphasized that the use of salt substitutes might enhance the efficacy of anti‐hypertensive medications in lowering blood pressure and reducing the risk of adverse cardiovascular events.
Keywords: blood pressure, cardiovascular events, medication, salt substitute
1. INTRODUCTION
Cardiovascular diseases (CVD) represent the leading cause of mortality worldwide and in China, and the health and economic burden of CVD is increasing with the aging of the population. 1 , 2 , 3 It is estimated that approximately 330 million individuals were afflicted with CVD and 245 million people suffering from hypertension in China. 4 Secondary prevention based on medication therapy, has been widely employed to regulate the principal risk factors. 5 Currently, the reduction of the burden of cardiovascular disease is largely dependent on adherence to medication treatment and the control of risk factors in a targeted manner. Furthermore, a reduction in sodium intake represents a fundamental lifestyle change that can help to control blood pressure and reduce the incidence of CVD. 5 , 6 , 7 , 8 , 9
The guidelines for the prevention of CVD 10 , 11 recommend that high‐risk patients reduce their sodium intake both before and during pharmacological interventions. 12 , 13 Salt substitutes, which replace a proportion of sodium chloride in regular salt with potassium chloride, offer the combined benefits of sodium reduction and potassium supplementation, making them a potentially more cost‐effective non‐pharmacological intervention. 14 , 15 As a strategy for reducing salt intake, salt substitutes have been proven effective in lowering blood pressure and preventing cardiovascular events. 16 , 17 , 18 Previous studies have demonstrated that salt substitutes were more effective in lowering blood pressure in people with higher blood pressure. 19 , 20
However, it remains unclear whether this effect on blood pressure levels is related to the use of antihypertensive medications. In this study, we utilized data from the SSaSS trial conducted in Shanxi Province to investigate the differences in cumulative cardiovascular events and blood pressure changes from baseline between the salt substitute and the regular salt group within the subgroup of participants at high cardiovascular risk who taking different antihypertensive medications or not.
2. METHODS
2.1. Study design and participants
The SSaSS was an open‐label, cluster‐randomized trial involving 600 villages in five provinces (Hebei, Liaoning, Ningxia, Shanxi, and Shaanxi) in Northern China. 21 Two counties from each province were selected based on prior collaboration and approximately 35 participants were recruited from each village. Participants were deemed at high cardiovascular risk, either with a history of stroke and/or being ≥60 years old with poorly controlled blood pressure (systolic blood pressure ≥140 mmHg for those receiving blood‐pressure‐lowering medication or ≥160 mmHg for those not receiving medication). 17 Participants were excluded if: (1) the participants or any household members had potential contraindications to the use of salt substitutes, such as using potassium‐sparing diuretics, potassium supplements, or having known serious kidney disease; (2) participants’ life expectancy was expected to be less than 6 months; or (3) participants ate most meals outside the home. 21 For this analysis, participants from 120 villages in Shanxi Province were included.
Recruitment in Shanxi province took place from July 2014 to August 2014. Once all participants had been enrolled and baseline survey data collected, randomization was conducted, stratified by county (with 60 villages per county), using a centralized computerized process. Villages were randomly assigned to either the intervention or control group at a 1:1 ratio. Participants in the intervention group received a free supply of salt substitutes sufficient to replace all household usage of regular salt. The salt substitute provided for the intervention contained 75% sodium chloride and 25% potassium chloride. Meanwhile, participants in the control group continued to use regular salt as usual.
2.2. Outcomes and process indicators
The primary outcomes of interest were major adverse cardiovascular events. Follow‐up for cardiovascular outcomes was conducted between August 2014 and October 2019 at 6‐month intervals through a combination of face‐to‐face visits to participants and searching routinely collected health data—New Rural Cooperative Medical Scheme and National Mortality Surveillance System. If a possible event was identified, additional information was sought from participants, their family members, and any medical facilities that the participant had visited during the illness, whenever possible. All suspected outcomes were ascertained by an independent adjudication committee with any information available.
The secondary outcomes were the changes in blood pressure from baseline to the end of the trial, as blood pressure measurements at both the baseline and the end of the trial included all enrolled participants. Systolic and diastolic blood pressures were mainly measured twice with an automated device (OMRON HEM‐7124), with an interval of at least 5 min between the two measurements, and the two readings were averaged for data analysis. Participants who did not attend the end‐of‐trial blood pressure measurement due to illness (such as hospitalization) or death were replaced by the blood pressure value at their last follow‐up visit.
Every 12 months, an equal number of intervention and control villages were randomly selected to form a sub‐sample (at least 12 villages), and approximately 20 participants from each included village will be randomly selected to participate in the process indicators collection. 24‐h urine electrolyte excretion and blood pressure will be measured (six surveys in total) to assess the effectiveness of the intervention as the annual process indicators.
2.3. Statistical analysis
Summary effects on process indicators were determined from a random‐effect, inverse‐variance‐weighted meta‐analysis of the differences at each year of follow‐up. Mixed effect models were employed to assess the effect of salt substitutes on the primary and secondary outcomes adjusting for cluster variables (village) and potential confounding variables. The primary analyses in this study were adjusted for potential confounding factors, including age, sex (male = 1; female = 2), Body Mass Index (BMI> 24.6 = 1; BMI < = 24.6 = 2), baseline systolic blood pressure (SBP > 141 = 1; < = 141 = 2), baseline diastolic blood pressure (DBP > 79 = 1; < = 79 = 2), disease history (stroke or not; hypertension or not) and cardiovascular medications (use of antihypertensive agent or not, use of anti‐platelet agent or not, and use of lipid‐lowering agent or not). Generalized linear mixed models were employed with the incidence of each participant serving as the dependent variable to evaluate the effect of salt substitute on major cardiovascular adverse events. Linear mixed models were employed to assess the least squares mean change from baseline, with each participant's blood pressure changing from baseline to the end of the trial serving as the dependent variable. A hierarchical Poisson model based on the baseline characteristics was used for subgroup analysis to test the robustness of salt substitutes to the primary outcomes.
All the analyses were based on the intention‐to‐treat principle. Statistical analyses were performed with the use of R version 4.3.2 and R studio version 2022.12.0 Build 353, SPSS statistical software (IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY, USA) and Review Manager 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Statistical significance was set at two‐sided p < 0.05.
3. RESULTS
3.1. Basic characteristics
A total of 4211 participants at high cardiovascular risk from Shanxi Province were included in the analysis. The mean age for all participants was 63.44 years old at baseline, 56.33% were male, 96.96% had a history of stroke, 90.00% reported having received a diagnosis of hypertension, 87.63% were taking an antihypertensive agent, 59.27% were using calcium antagonist, 17.62% were using angiotensin‐converting to enzyme inhibitor or angiotensin‐receptor blocker (ARB/ACEi), 11.90% were using diuretic. Among the participants who were taking antihypertensive agents, 70.60% were taking single antihypertensive medication, and 17.03% were taking combined antihypertensive medications. Demographic characteristics of salt substitute group and regular salt group are basically balanced (Table 1).
TABLE 1.
Basic characteristics of overall participants in the trial.
| Baseline characteristics |
Total (n = 4211) |
Salt substitute (n = 2106) |
Regular salt (n = 2105) |
p |
|---|---|---|---|---|
| Sex | ||||
| Female, n (%) | 1839 (43.67) | 922 (43.78) | 917 (43.56) | 0.907 |
| Male, n (%) | 2372 (56.33) | 1184 (56.22) | 1188 (56.44) | 0.935 |
| Age (years), mean (SD) | 63.44 ± 8.43 | 63.72 ± 8.29 | 63.16 ± 8.43 | 0.030 |
| ≤64, n (%) | 2284 (54.24) | 1102 (52.33) | 1182 (56.15) | 0.094 |
| >64, n (%) | 1927 (45.76) | 1004 (47.67) | 923 (43.85) | 0.065 |
| BMI (kg/m2), mean (SD) | 24.62 ± 3.71 | 24.49 ± 3.82 | 24.76 ± 3.59 | 0.018 |
| ≤24.60, n (%) | 2235 (53.08) | 1147 (54.46) | 1088 (51.69) | 0.396 |
| >24.60, n (%) | 1976 (46.92) | 959 (45.54) | 1017 (48.31) | 0.192 |
| SBP (mmHg), mean (SD) | 140.57 ± 21.21 | 140.91 ± 21.02 | 140.22 ± 21.40 | 0.291 |
| <140 mmHg, n (%) | 2215 (52.60) | 1109 (52.66) | 1106 (52.54) | 0.949 |
| ≥140 and < 160 mmHg, n (%) | 1258 (29.87) | 618 (29.34) | 640 (30.4) | 0.535 |
| ≥160 mmHg, n (%) | 738 (17.53) | 379 (18.00) | 359 (17.06) | 0.462 |
| DBP (mmHg), mean (SD) | 78.88 ± 11.15 | 78.90 ± 11.25 | 78.86 ± 11.07 | 0.907 |
| <90 mmHg, n (%) | 3554 (84.4) | 1763 (83.71) | 1791 (85.08) | 0.639 |
| ≥90 and < 100 mmHg, n (%) | 488 (11.59) | 254 (12.06) | 234 (11.12) | 0.365 |
| ≥100 mmHg, n (%) | 169 (4.01) | 89 (4.23) | 80 (3.80) | 0.489 |
| Education | ||||
| Primary school or lower | 2727 (64.76) | 1392 (66.10) | 1335 (63.42) | 0.275 |
| Junior high school or higher | 1484 (35.24) | 714 (33.90) | 770 (36.58) | 0.146 |
| Disease history | ||||
| Stroke, n (%) | 4083 (96.96) | 2048 (97.25) | 2035 (96.67) | 0.839 |
| Hypertension, n (%) | 3790 (90.00) | 1872 (88.89) | 1918 (91.12) | 0.455 |
| Ischemic heart disease (%) | 422 (10.02) | 231 (10.97) | 191 (9.07) | 0.052 |
| Diabetes mellitus (%) | 383 (9.10) | 200 (9.50) | 183 (8.69) | 0.385 |
| Transient ischemic attack (%) | 91 (2.16) | 33 (1.57) | 58 (2.76) | 0.009 |
| Peripheral arterial disease(%) | 30 (0.71) | 12 (0.57) | 18 (0.86) | 0.273 |
| Congestive heart failure | 21 (0.50) | 6 (0.28) | 15 (0.71) | 0.050 |
| Medication use | ||||
| Antihypertensive agent, n (%) | 3690 (87.63) | 1805 (85.71) | 1885 (89.55) | 0.188 |
| Calcium antagonist, n (%) | 2496 (59.27) | 1214 (57.64) | 1282 (60.90) | 0.174 |
| ACEI/ARB, n (%) | 742 (17.62) | 367 (17.43) | 375 (17.81) | 0.769 |
| Diuretic, n (%) | 501 (11.90) | 266 (12.63) | 235 (11.16) | 0.166 |
| Other antihypertensive agent, n (%) | 726 (17.24) | 360 (17.09) | 366 (17.39) | 0.824 |
| Single antihypertensive medication use, n (%) | 2973 (70.60) | 1434 (68.09) | 1539 (73.11) | 0.054 |
| Combined antihypertensive medication use, n (%) | 717 (17.03) | 371 (7.62) | 346 (16.44) | 0.351 |
| Aspirin or other antiplatelet agent, n (%) | 2425 (57.58) | 1199 (59.63) | 1226 (58.24) | 0.584 |
| Station or other lipid‐lowering agent, n (%) | 964 (22.89) | 488 (23.17) | 476 (22.61) | 0.699 |
Abbreviation: ACEI/ARB, angiotensin‐converting enzyme inhibitor/angiotensin‐receptor blocker.
3.2. Process indicators
Over the five‐year follow‐up, the mean difference in 24‐h urinary sodium/potassium ratio was ‐2.47 (95% CI: ‐3.23 to ‐1.71) between the salt‐substitute group and the regular‐salt group. The mean difference in systolic blood pressure was ‐3.45 mmHg (95% CI: ‐6.50 to ‐0.40) between the salt‐substitute group and the regular‐salt group, and the mean difference in diastolic blood pressure was ‐1.26 mmHg (95% CI: ‐2.34 to ‐0.18) (Figure 1).
FIGURE 1.
Effect of salt substitute on process indicators.
3.3. Cardiovascular outcomes
During the average follow‐up period of 4.66 years, the protective effect of salt‐substitute was significant in the risk of major adverse cardiovascular events(34.22 events vs. 40.25 events per 1000 person‐years; rate ratio, 0.83; 95% CI: 0.71 to 0.96; p = 0.015) and all‐cause death (17.47 events vs. 19.52 events per 1000 person‐years; rate ratio, 0.85; 95% CI: 0.74 to 0.96; p = 0.012). No participants were identified with definite hyperkalemia, but a further 94 participants who had died, were identified as having probable hyperkalemia. Salt substitute has no significant effect on the risk of hyperkalemia (5.18 events vs. 4.39 events per 1000 person‐years; rate ratio, 1.08; 95% CI: 0.70 to 1.67; p = 0.741) (Figure 2).
FIGURE 2.
Effects of salt substitute on cardiovascular outcomes.
Among the participants who were taking antihypertensive medications, the salt substitute was also observed to protect against the major adverse cardiovascular events (28.63 events vs. 35.96 events per 1000 person‐years; rate ratio 0.81, 95%CI: 0.68 to 0.95, p = 0.011) and all‐cause death (17.77 events vs. 21.07 events per 1000 person‐years; rate ratio, 0.83; 95% CI: 0.72 to 0.96; p = 0.010). However, no significant protective effect was observed in participants not taking antihypertensive medications, regardless of the risk of major adverse cardiovascular events (Figure 3) or all‐cause death (Figure 4).
FIGURE 3.
Subgroup analysis of the effects of salt substitute on major adverse cardiovascular events.
FIGURE 4.
Subgroup analysis of the effects of salt substitute on all‐cause death.
Significant protective effects of salt substitute were observed in the subgroups taking single antihypertensive medication against the risk of major adverse cardiovascular events(16.87 events vs. 21.30 events per 1000 person‐years, rate ratio 0.82, 95%CI: 0.68 to 0.97, p = 0.022) and all‐cause death(18.08 events vs. 21.90 events per 1000 person‐years, rate ratio 0.84, 95%CI: 0.72 to 0.97, p = 0.020) (Table 2 and 3).
TABLE 2.
Effect of salt substitute on related cardiovascular events in different subgroups of antihypertensive medications.
| Total major cardiovascular events (per 1000 person‐years) | All‐cause death (per 1000 person‐years) | |||||||
|---|---|---|---|---|---|---|---|---|
| Subgroup | Salt substitute | Regular salt | Rate ratio (95%CI) | p | Salt substitute | Regular salt | Rate ratio (95%CI) | p |
| Single medication use | 16.87 | 21.30 | 0.82 (0.68, 0.97) | 0.022 | 18.08 | 21.90 | 0.84 (0.72, 0.97) | 0.020 |
| Combined medication use | 17.55 | 20.93 | 0.76 (0.52, 1.13) | 0.173 | 16.51 | 17.69 | 0.86 (0.62, 1.18) | 0.349 |
TABLE 3.
Effect of salt substitute on related cardiovascular events in people taking different antihypertensive medications.
| Total major cardiovascular events (per 1000 person‐years) | All‐cause death (per 1000 person‐years) | |||||||
|---|---|---|---|---|---|---|---|---|
| Medication | Salt substitute | Regular salt | Rate ratio (95%CI) | p | Salt substitute | Regular salt | Rate ratio (95%CI) | p |
| Calcium antagonist | 18.08 | 21.46 | 0.86 (0.70, 1.06) | 0.159 | 17.77 | 20.42 | 0.85 (0.72, 1.02) | 0.074 |
| ACEI/ARB | 15.63 | 25.55 | 0.59 (0.42, 0.83) | 0.002 | 15.38 | 18.80 | 0.79 (0.57, 1.09) | 0.150 |
| Diuretic | 19.26 | 11.38 | 1.52 (0.95, 2.45) | 0.082 | 17.36 | 15.67 | 1.02 (0.67, 1.55) | 0.935 |
| Other | 13.28 | 24.08 | 0.54 (0.38, 0.77) | <0.001 | 19.06 | 26.50 | 0.76 (0.60, 0.97) | 0.025 |
Abbreviation: ACEI/ARB, angiotensin‐converting enzyme inhibitor/angiotensin‐receptor blocker.
3.4. Blood pressure change from baseline
In participants on antihypertensive agent, salt substitute compared with regular salt lowered blood pressure from baseline by ‐4.34 mmHg systolic blood pressure (95% CI: ‐6.04 to ‐2.64, p < 0.001) and ‐1.31 mmHg diastolic blood pressure (95% CI: ‐2.44 to ‐0.20, p = 0.021). Furthermore, a similar effect was observed regardless of the participants in the use of single antihypertensive medications or combined medication use (Table 4). Even when taking different types of antihypertensive medications, substitutes had a significant effect on reducing systolic blood pressure compared with the corresponding regular salt group (Table 5).
TABLE 4.
Effect of salt substitute on blood pressure changes from baseline (LS mean ± SE) in different subgroups of antihypertensive medications.
| SBP change from baseline | DBP change from baseline | |||||||
|---|---|---|---|---|---|---|---|---|
| Subgroup | Salt substitute | Regular salt |
Mean difference (95%CI) |
P | Salt substitute | Regular salt |
Mean difference (95%CI) |
p |
| Any antihypertensive medication | −1.37 ± 2.98 | 2.97 ± 2.95 | −4.34(−6.04, −2.64) | <0.001 | 1.17 ± 1.76 | 2.49 ± 1.74 | −1.31(−2.44, −0.20) | 0.021 |
| Single medication use | −1.25 ± 3.12 | 2.64 ± 3.09 | −3.89 (−5.61, −2.17) | <0.001 | 0.56 ± 1.85 | 1.57 ± 1.83 | −1.32 (−2.43, −0.20) | 0.021 |
| Combined medication use | −5.35 ± 11.18 | 0.80 ± 11.12 | −6.15 (−9.29, −3.00) | <0.001 | 7.55 ± 6.43 | 9.08 ± 6.40 | −1.53 (−3.37, 0.31) | 0.102 |
TABLE 5.
Effect of salt substitute on blood pressure changes from baseline (LS mean ± SE) in people taking different antihypertensive medications.
| Systolic blood pressure changes from baseline | Diastolic blood pressure changes from baseline | |||||||
|---|---|---|---|---|---|---|---|---|
| Medication | Salt substitute | Regular salt |
Mean difference (95%CI) |
p | Salt substitute | Regular salt |
Mean difference (95%CI) |
P |
| Calcium antagonist | −3.28 ± 3.93 | 0.57 ± 3.89 | −3.85 (−5.74, −1.95) | <0.001 | 0.99 ± 2.31 | 1.91 ± 2.29 | −0.92 (−2.11, 0.27) | 0.131 |
| ACEI/ARB | 7.87 ± 10.15 | 13.67 ± 10.08 | −5.80 (−9.15, −2.45) | 0.001 | 11.12 ± 5.99 | 12.50 ± 5.95 | −1.39 (−3.38, 0.60) | 0.171 |
| Diuretic | −12.18 ± 11.00 | −5.96 ± 10.92 | −6.22 (−9.41, −3.04) | <0.001 | 4.11 ± 6.20 | 5.90 ± 6.20 | −1.79 (−3.86, 0.28) | 0.089 |
| Other | 4.04 ± 6.09 | 8.94 ± 6.06 | −4.90 (−7.36, −2.44) | <0.001 | 0.06 ± 3.63 | 2.31 ± 3.61 | −2.25 (−3.89, −0.60) | 0.007 |
Abbreviation: ACEI/ARB, angiotensin‐converting enzyme inhibitor/angiotensin‐receptor blocker.
4. DISCUSSION
Through the five‐year follow‐up intervention in high cardiovascular risk patients with a history of stroke or hypertension from 120 villages of Shanxi Province, the results emphasized that the combination of salt substitute with antihypertensive medication therapy significantly reduced blood pressure and the incidence of major cardiovascular adverse events. Prior studies had demonstrated that salt reduction was additive to antihypertensive treatments, with the greatest effect observed when both were employed simultaneously. 22 , 23 , 24 Nevertheless, a meta‐analysis showed that the use of an antihypertensive agent had little effect on the BP effects of sodium reduction. 25 There were two reasons for this result: First, all the studies included in the meta‐analysis were experimental studies, not population studies. Second, the subjects included involved both hypertensive patients and non‐hypertensive patients. In the present trial, systolic blood pressure and diastolic blood pressure decreased by 4.34 mmHg (p < 0.001) and 1.31 mmHg (p = 0.021), respectively, in participants who received the salt substitute compared to regular salt group in the population taking antihypertensive medications. These findings were consistent with those of a pilot study in hypertension patients, which indicated that salt substitute had the potential to reduce blood pressure and reduce the use of antihypertensive medications. 26
Maintaining long‐term stability of blood pressure was also conducive to reducing the risk of cardiovascular adverse events. 27 In this study, although salt substitutes significantly lowered systolic blood pressure, the effect on reducing the risk of cardiovascular events varied in different subgroups of antihypertensive medications. The main finding was that the protective effect of salt substitute was significant in the subgroup taking single antihypertensive medication, but not in the group taking combined antihypertensive medications, which might be attributed to two reasons: First, it was related to the sample size. The proportion of participants taking single anti‐hypertensive medication(70.60%) was larger than that of those taking combined antihypertensive medications(17.03%). The larger the sample population, the more endpoint events can be observed. Second, it could be related to the risk of cardiovascular events: people taking combined antihypertensive medications were at high risk of uncontrolled blood pressure to a certain extent, 28 so the protective effect of salt substitutes may be relatively insignificant in this group of people.
Furthermore, previous studies have indicated that the protective effects against cardiovascular risk were primarily due to the reduction in blood pressure itself, rather than the specificity of any antihypertensive medications. 29 However, a significant protective effect was observed in participants taking ACEI/ARB (rate ratio: 0.59; 95%CI: 0.42 to 0.83; p = 0.002). The effect of salt substitutes and specific antihypertensive medications and their combinations needs to be further established in a wider population.
To the best of our knowledge, the study represented the pioneering investigation into the combined effects between salt substitutes and antihypertensive medications. It should be noted that this study is not without limitations. First, the sample population of this study was derived solely from the SSASS trial conducted in Shanxi province, and the large difference in sample size of those taking different types of antihypertensive medications might limit the extrapolation of the results. Second, diseases often require a long period of time for their onset and progression, while both medication treatment and salt substitutes require a long period of time for their preventive effect. It is regrettable that this study only encompassed a five‐year follow‐up period with limited incidence rates, which might have constrained the evaluation of such interactions. Consequently, future research endeavors will focus on conducting longer post‐intervention follow‐ups in order to comprehensively observe the interplay between salt substitute usage and medication use.
5. CONCLUSIONS
This study found combining salt substitutes with antihypertensive medications could be significantly conducive to blood pressure control and the risk reduction of major adverse cardiovascular events among high cardiovascular risk patients with a history of stroke or hypertension.
CONFLICT OF INTEREST STATEMENT
The authors declare no conflict of interest.
PATIENT CONSENT STATEMENT
Written informed consent was provided by the participant.
CLINICAL TRIAL REGISTRATION
SSaSS ClinicalTrials.gov number, NCT02092090
ACKNOWLEDGMENTS
This study was supported by the Changzhi Medical College Doctoral Startup Fund (No.2024BS14), National Health and Medical Research Council of Australia (NHMRC) Project Grant (APP1049417), NHMRC Program Grant (APP1052555), and NHMRC Centre for Research Excellence Grant (APP1117300).
Qi Z, Tang S, Hao Y, et al. Effect of salt substitute and antihypertensive medications among high cardiovascular risk patients: A sub‐study of Salt Substitute and Stroke Study (SSaSS). J Clin Hypertens. 2024;26:1063–1072. 10.1111/jch.14872
Zijing Qi and Shuai Tang contributed equally to the work.
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author, upon reasonable request.