Hypertension is a common and major risk factor for the leading US killer, cardiovascular disease. 1–5 Reducing excess dietary sodium can lower blood pressure, with a greater response among persons with hypertension. 6–9 Nine of 10 Americans consume excess dietary sodium, defined as more than 2300 mg per day. 10, 11 Many leading medical and public health organizations recommend reducing dietary sodium to a maximum of 2300 mg per day on the basis of evidence indicating a public health benefit. 11–17 Yet this benefit has been questioned, mainly on the basis of studies suggesting that low sodium intake is also associated with an increased risk of cardiovascular disease. 18–22

In science, conflicting evidence from studies with methods of different strengths is not uncommon. Studies that measure sodium intake vary widely in their methods and should be judged accordingly. Accurate measurement matters. 23–26 Paradoxical findings based on inaccurate sodium measurements should not stall efforts to improve the food environment in ways that enable consumers to reduce excess sodium intake. Gradual, stepwise sodium reduction, as recommended by the Institute of Medicine, 27 remains an achievable, effective, and important public health strategy to prevent tens of thousands of heart attacks and strokes and save billions of dollars in health care costs annually. 28