(Strong for | Not Reviewed, Not Changed) Discussion Many national and international organizations recommend reducing sodium intake for the prevention and management of HTN, with the ultimate goal of reducing associated morbidity and mortality. New evidence was not reviewed as part of this CPG update; evidence reviewed during the 2014 VA/DoD HTN CPG update is summarized below. There is a strong body of evidence from animal studies and human observational and experimental studies noting a dose-dependent relationship between dietary sodium intake and blood pressure in both normotensive and hypertensive individuals, though there is known variation in salt sensitivity both within and across populations. It should be noted that recommendations for dietary sodium reduction to reduce cardiovascular risk generally rely on surrogate markers (e.g., blood pressure) rather than clinical outcomes. The current guideline recommends a reduction to 2300 mg/day. There is strong clinical evidence from the DASH sodium trial that a reduction from 3400 mg (average daily intake of U.S. adults) to 2300 mg (the previously defined tolerable upper intake level [UL] [125])12 improves blood pressure in the short term.[126] Limited observational research suggests that CVD event rates also decrease with reductions in sodium intake Two relevant RCTs addressing blood pressure and/or mortality outcomes for reducing sodium intake were reviewed during the 2014 VA/DoD HTN CPG update. The Trials of Hypertension Prevention Phase II (TOHP II) 12 There is no longer a defined UL for sodium, as there is no toxicological indicator specific to excessive sodium intake. The 2019 Dietary Reference Intakes now include a new category, the Chronic Disease Risk Reduction Intake (CDRR), or intake above which intake reduction is expected to reduce chronic disease risk in an apparently healthy population. 