Sodium Restriction in Heart Failure: Too Much Uncertainty—Do the Trials

Guidelines have mandated empirical thresholds that are to be respected, and consensus statements from leading organizations further make the case for sodium restriction as a basic tenet of good cardiovascular care. However, like many other dogmatic statements that were fully embedded in cardiovascular medicine, the time has now come for sodium restriction in heart failure to be critically reevaluated. There is simply too much uncertainty for a conviction we hold as truth. At a minimum, rigorous testing in well-performed randomized clinical trials is needed. There should be only 1 goal: valid evidence leading to a much more informed position, actionable guidelines, and personalized implementation.