Introduction: Hypertension is a leading modifiable risk factor for cardiovascular disease and chronic kidney disease. Despite the availability of pharmacotherapy, therapeutic non-adherence remains a significant barrier to blood pressure (BP) control. Low-Sodium Salt Substitutes (LSSS) offer a promising non-pharmacological strategy to bridge this adherence gap.

Case Presentation: A 44-year-old female with a history of right nephrectomy and chronic non-adherence to antihypertensive therapy presented to the outpatient department with severe occipital headaches and a BP of 160/100 mmHg. Given her solitary kidney, a specialized intervention focusing on sodium reduction was initiated. The patient was started on a strict LSSS protocol alongside restarted pharmacotherapy.

Results: Over an eight-week follow-up period, the patient demonstrated high adherence to the LSSS regimen. Her BP stabilized from 160/100 mmHg to 110/70 mmHg. Significant secondary outcomes included a 9.3 kg weight reduction (67.3 kg to 58.0 kg) and the resolve of persistent headaches. Renal parameters remained optimal, with serum creatinine improving from 0.75 mg/dL to 0.50 mg/dL, and electrolytes remained stable (Potassium 4.0–4.3 mmol/L).

Conclusion: This case demonstrates that LSSS is a highly effective, safe, and low-cost modality for managing uncontrolled hypertension in high-risk patients, including those with a solitary kidney. The intervention not only facilitated rapid BP stabilization but also supported significant weight loss and renal preservation. These findings support the wider implementation of LSSS in primary care to meet global World Health Organization (WHO) sodium reduction targets.