Dietary Sodium Intake in Heart Failure

Dietary sodium restriction is arguably the most frequent self-care behavior recommended to patients with heart failure (HF)1,2 and is endorsed by all HF guidelines.2–10 However, the data on which this recommendation is drawn are modest, and the limited trials conducted have produced inconsistent findings. Americans consume ≈3700 mg sodium daily,11 whereas the US Department of Agriculture and the Department of Health and Human Services recommend 2300 mg daily intake for the general population, with a stricter recommendation of 1500 mg/d for those >50 years of age, blacks, or individuals with hypertension, diabetes mellitus, or chronic kidney disease.12 According to a recent report from the National Health and Nutrition Examination Survey, although 47.6% of persons aged ≥2 years meet the criteria to limit daily sodium intake to 1500 mg, the usual intake for 98.6% of those persons was >1500 mg; in 88.2% of the remaining population, daily intake was greater than the recommended <2300 mg.13 The American Heart Association now recommends sodium intake of 1500 mg/d for all Americans,14 similar to the recommendation by the Institute of Medicine.15 Interestingly, and paradoxically, the suggested 1500 mg daily sodium intake for the general population is less than the limit proposed for HF patients by most guidelines, which appears as a contradiction. Whether this contradiction suggests inconsistent policy or a limited understanding of sodium homeostasis in the HF versus non-HF state is debatable. Sodium homeostasis physiology is altered in HF as opposed to healthy individuals and those with hypertension, and may partially explain these incongruous recommendations. This review summarizes the studies assessing the effects of sodium restriction in HF, highlighting knowledge gaps and future directions. Excessive sodium intake is associated with fluid retention. Therefore, all HF management guidelines recommend sodium restriction. In 2005, …