title: Launching a salt substitute to reduce blood pressure at the population level: a cluster randomized stepped wedge trial in Peru.
abstract: BACKGROUND
  Controlling hypertension rates and maintaining normal blood pressure, particularly in resource-constrained settings, represent ongoing challenges of effective and affordable implementation in health care. One of the strategies being largely advocated to improve high blood pressure calls for salt reduction strategies. This study aims to estimate the impact of a population-level intervention based on sodium reduction and potassium increase - in practice, introducing a low-sodium, high-potassium salt substitute - on adult blood pressure levels.
  
  
  METHODS
  The proposed implementation research study includes two components: Phase 1, an exploratory component, and Phase 2, an intervention component. The exploratory component involves a triangle taste test and a formative research study designed to gain an understanding of the best implementation methods. Phase 2 involves a pragmatic stepped wedge trial design where the intervention will be progressively implemented in several clusters starting the intervention randomly at different times. In addition, we will evaluate the implementation strategy using a cost-effectiveness analysis.
  
  
  CONCLUSIONS
  This is the first project in a Latin-American setting to implement a salt substitution intervention at the population level to tackle high blood pressure. Data generated and lessons learnt from this study will provide a strong platform to address potential interventions applicable to other similar low- and middle-income settings.
  
  
  BACKGROUND
  This study is registered in ClinicalTrials.gov NCT01960972.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
authors.forename: Francisco
authors.initials: F
authors.lastname: Diez-Canseco
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.forename: María K
authors.initials: MK
authors.lastname: Cárdenas
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Sacksteder
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Av, Armendariz 497, Miraflores, Lima 18, Peru. jaime.miranda@upch.pe.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002985:Clinical Protocols; D004039:Diet, Sodium-Restricted; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010568:Peru; D017419:Potassium, Dietary / Q000008:administration & dosage; D064167:Recommended Dietary Allowances; D012107:Research Design; D017673:Sodium Chloride, Dietary / Q000009:adverse effects*; D013649:Taste; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D017419:Potassium, Dietary; D017673:Sodium Chloride, Dietary