[122] This approach allows for the detection of potential additive and/or synergistic effects of these nutrients which might individually be too small to detect. The DASH diet has been shown to reduce SBP and DBP in both hypertensive and normotensive adults, whether at dietary sodium intakes similar to the average daily consumption [123] or in combination with varying degrees of sodium restriction.[122] Combining the DASH diet with sodium restriction consistently produces larger decreases in blood pressure than either intervention alone across As this is a Not Reviewed, Amended recommendation, the Work Group did not systematically review new evidence related to this recommendation. However, confidence in the quality of the evidence systematically reviewed for the 2014 VA/DoD HTN CPG is high.[122-124] Benefits outweigh harms, though patient preferences regarding dietary modification may vary. Some patients may be resistant to changing eating patterns or face geographical or financial barriers to accessing certain types of healthy foods. Others may have high levels of motivation to improve diet quality in an effort to reduce pill burden. Patient focus group participants indicated that initial referral to a dietitian is common but expressed the desire for spouses/caregivers to be included in nutrition interventions when possible. The current guideline continues to recommend the DASH diet based on the existing body of evidence to support its use in lowering blood pressure. Recommendation 21. In patients with hypertension, we recommend that sodium intake be limited to no more than 2,300 mg/day (100 mmol/day), with referral to a dietitian or other support as appropriate. (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. 