A Radical Sodium Reduction Policy Is Not Supported by Randomized Controlled Trials or Observational Studies: Grading the Evidence

Am J Hypertens. 2016 May;29(5):543-8. doi: 10.1093/ajh/hpw006. Epub 2016 Jan 27.


Several health institutions recommend sodium intake be reduced to below 2,300 mg, which means that 6-7 billion individuals should alter their diet to accommodate. Such a radical recommendation should be based on solid evidence. However, this review reveals that (i) there are no randomized controlled trials (RCTs) allocating individuals to below 2,300 mg and measuring health outcomes; (ii) RCTs allocating risk groups such as obese prehypertensive individuals and hypertensive individuals down to (but not below) 2,300 mg show no effect of sodium reduction on all-cause mortality; (iii) RCTs allocating individuals to below 2,300 mg show a minimal effect on blood pressure in the healthy population (less than 1mm Hg) and significant increases in renin, aldosterone, noradrenalin cholesterol, and triglyceride; and (iv) observational studies show that sodium intakes below 2,645 and above 4,945 mg are associated with increased mortality. Given that 90% of the worlds' population currently consumes sodium within the optimal range of 2,645-4,945 mg, there is no scientific basis for a public health recommendation to alter sodium intake.

Keywords: blood pressure; catecholamines; cholesterol; hypertension; mortality; observational study; randomized controlled trial; renin–angiotensin–aldosterone system; sodium; triglyceride..

Publication types

  • Review

MeSH terms

  • Blood Pressure*
  • Cause of Death
  • Diet, Sodium-Restricted* / adverse effects
  • Evidence-Based Medicine*
  • Humans
  • Hypertension / diagnosis
  • Hypertension / diet therapy*
  • Hypertension / mortality
  • Hypertension / physiopathology
  • Observational Studies as Topic*
  • Randomized Controlled Trials as Topic*
  • Recommended Dietary Allowances
  • Risk Assessment
  • Risk Factors
  • Sodium Chloride, Dietary / adverse effects*
  • Treatment Outcome


  • Sodium Chloride, Dietary