More than 130 million adults in the US have hypertension, and national rates of blood pressure (BP) control have declined in recent years. This high burden of hypertension is driven in part by the US diet. The average US adult consumes 3.4 g of sodium daily, approximately 70% of which comes from the packaged and pre-prepared foods that define much of our culinary culture. Several randomized clinical trials have demonstrated that lowering sodium intake leads to lower BP, particularly among individuals with higher baseline BP. Population-level randomized interventions have shown that sodium restriction with potassium-based salt substitutes reduces the incidence of hypertension and stroke. Accordingly, dietary sodium restriction is considered by many health care practitioners and public health officials to be a cornerstone of hypertension prevention and management. However, others argue that sodium restriction should not be recommended broadly due to insufficient evidence of cardiovascular risk reduction, and that sodium restriction may be best targeted only to individuals with high sodium intake and “salt-sensitive” hypertension.
