Learning Objectives

• To discuss updated information on the epidemiology of hypertension, especially regarding the role of hypertension in the global burden of cardiovascular disease
• To examine clinically relevant mechanisms of hypertension, particularly those that foster salt sensitivity
• To discuss recent developments in the use of out-of-office BP monitoring in the care of hypertensive patients
• To describe recent developments in secondary hypertension, particularly in pheochromocytoma, renovascular disease, and primary aldosteronism
• To discuss and analyze recent hypertension guidelines and clinical trials guiding the care of patients who are hypertensive

It is the policy of the American Society of Nephrology (ASN) that all individuals in a position to control the content of ASN's educational activities are expected to disclose all their and their life spouse/partner's financial relationships with “ineligible companies” within the prior 24 months as well as other non-financial interests. (“Ineligible companies” are those whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients.) Participants should note that the use of products outside U.S. Food and Drug Administration (FDA) approved labeling should be considered experimental and are advised to consult current prescribing information for approval indications.

The intent of this policy is not to prevent expert faculty with relevant relationship(s) with commercial interest(s) from involvement in educational activities, but rather to ensure that these activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of control from commercial interests and free of commercial bias. In addition, all faculty were instructed to provide balanced, scientifically rigorous, and evidence-based presentations.

ASN requires all individuals in a position to control content for this activity to complete disclosure forms on the ASN website. Responses are listed below.

Disclosures have been reviewed and assessed by ASN. All relationships with ineligible companies have been identified and all relevant financial relationships have been mitigated.

View the full ASN Conflict of Interest and Disclosure Policy: https://www.asn-online.org/education/cme/coi-disclosure.pdf.

EDITORS:

Alice M. Sheridan, MD—Employer(s): Brigham and Women’s Hospital; No additional relevant financial relationship(s) with ineligible companies to disclose.

Martina M. McGrath, MBChB, FASN—Employer(s): Brigham and Women’s Hospital; VA Boston Medical Center; No additional relevant financial relationship(s) with ineligible companies to disclose.

EDITORIAL AUTHOR:

George L. Bakris, MD, FASN—Employer(s): The University of Chicago Medicine; Consultancy: Janssen, Bayer, Vascular Dynamics, KBP Biosciences, Merck, Novo Nordisk, Astra-Zeneca, Ionis, Alnylam, Cyclerion Therapeutics, Horizon Pharma, Medscape; Research Funding: Bayer, Novo Nordisk, Vascular Dynamics-Funding for steering committee activities and goes to the University of Chicago Medicine; Honoraria: Merck, Novo Nordisk, Astra Zeneca, Ionis, Alnylam, KBP Biosciences, Teijin and Bayer; Advisory or Leadership Role: Merck, KBP Biosciences, Teijin, American J Nephrology–Editor, Diabetes Care–Assoc. Ed., American Heart Assoc., UpToDate–Nephrology; Other Interests or Relationships: National Kidney Foundation, American Diabetes Association, American Heart Association, Blood Pressure Council

AUTHORS:

Debbie L. Cohen, MD, FASN—Employer(s): University of Pennsylvania; Consultancy: Medtronic, Recor, metavention, novartis; Ownership Interest: incyte, kura - spouse; Research Funding: Medtronic; Recor, CRIC study; Honoraria: Medtronic, Recor, metavention, novartis; Patents or Royalties: incyte - spouse; Advisory or Leadership Role: spouse - kura oncology - spouse; Speakers Bureau: Medtronic

Jordana B. Cohen, MD, MS—Employer(s): University of Pennsylvania; Other Interests or Relationships: Research grant funding from the National Institutes of Health (K23-HL133843, R01-HL153646, R01-HL157108, U01-HL160277, U01-TR003734, R01-DK123104, U24-DK060990, and R01-AG074989) and the American Heart Association (Bugher Award)

Peter von Dadelszen, MBChB, PhD—Employer(s): King's College London, UK; Ownership Interest: Nightingale Medical Ltd (UK)

Gregory L. Hundemer, MD, MPH—Employer(s): The Ottawa Hospital; No additional relevant financial relationship(s) with ineligible companies to disclose.

Eric Judd, MD, MS—Employer(s): University of Alabama at Birmingham; Consultancy: Medpace Cincor Pharma: member of data monitoring committee

Laura A. Magee, MD, MSc—Employer(s): King's College London, UK; Ownership Interest: Shares in Nightingale Medical Ltd. (UK); Advisory or Leadership Role: Pregnancy Hypertension, Hypertension, Frontiers in Global Women's Health

Suzanne Oparil, MD—Employer(s): University of Alabama at Birmingham; Ownership Interest: CinCor Pharma Inc; Research Funding: Bayer (site PI-diabetic kidney disease); CinCor Pharma Inc (site PI-primary aldosterone study); George Clinical Pty (site PI-GMRx2 treatment of hypertension); Higi (site PI-BP validation study); Advisory or Leadership Role: CinCor Pharma Inc (Scientific Advisory Board (SAB) primary aldosteronism and hypertension); Preventric Diagnostics, LLC (Chair Medical & Technology Committee; 03/2019 – present); Other Interests or Relationships: Editor-in-Chief, Current Hypertension Reports (Journal; Publisher – Springer Science Business Media LLC), annual stipend of $5,000 (Springer); Editor-in-Chief Term until 12/2022.

Sandra J. Taler, MD—Employer(s): Mayo Clinic, Staff physician; American Journal of Hypertension, Associate Editor; No additional relevant financial relationship(s) with ineligible companies to disclose.

Raymond R. Townsend, MD—Employer(s): University of Pennsylvania School of Medicine; No additional relevant financial relationship(s) with ineligible companies to disclose.

ASN STAFF:

Suzanne P. Armstrong, MA—Employer(s): American Society of Nephrology; No additional relevant financial relationship(s) with ineligible companies to disclose.

Commercial Support

There is no commercial support for this issue.

The nephSAP editorial team and the KSAP editorial board extend their sincere appreciation to the following reviewers. Their efforts and insights help improve the quality of these postgraduate education offerings. 

nephSAP Review Panel, Volume 21, Number 4, September 2022

• Sandeep Aggarwal, MBBS, MD, FASN, University of Pennsylvania, United States
• Hayder Aledan, MD, FASN, University of Basrah, Iraq
• Alejandro Claudio Alvarez Ortiz, MD, Nephrology and Hypertension Specialists, United States
• Andrea Angioi, MD, FASN, Azienda Ospedaliera G.Brotzu, Italy
• Puneet Arora, DrMed, MBBS, MD, Max Super Specialty Hospital-Dehradun, India
• Ines Dionisio Coelho, MD, Hospital Amato Lusitano, Portugal
• Arvind K. Garg, MBBS, MD, FASN, Mayo Clinic Health System, United States
• Samir Chandra Gautam, MBBS, MD, FASN, Johns Hopkins University Hospital, United States
• Lali (Lalarukh) Haider, MD, University of CT Health Center, United States
• Tazeen H. Jafar, MD, MPH, FASN, Duke-NUS Graduate Medical School, Singapore
• Vishal Jaikaransingh, MBBS, University of Florida College of Medicine, United States
• Quresh T. Khairullah, MD, FASN, St. Clair Nephrology, United States
• Sudhir K. Khanna, MD, Integris Health, United States
• Biresh Kumar, MD, Central Texas Nephrology Associates, United States
• Muhammad Ahmad Mujtaba, MD, FASN, University of Texas Medical Branch, United States
• Frank J.O Brien, MD, FASN, Washington University in St. Louis, United States
• Sunil H. Patel, DO, Advanced Medical and Kidney Institute, United States
• Shivangi Patel, MD, Atlantic Health System, United States
• Dwarakanathan Ranganathan, MD, FASN, Metro North Hospitals, Brisbane, Australia
• Karthik M. Ranganna, MD, MBA, FASN, Tower Health/ Drexel University College of Medicine, United States
• Nitesh Nikilesh Rao, MBBS, MD, Central Northern Adelaide Renal Transplantation Service, Australia
• Bijan Roshan, MD, FASN, Scripps Health Clinic, United States
• M. Lee Sanders, MD, PhD, FASN, University of Iowa Hospitals and Clinics, United States
• Alan Segal, MD, MS, Maine Health, United States
• Ashutosh Singh, MD, FASN, Nephrocare Tennessee, PLLC, United States
• Tripti Singh, MBBS, MD, FASN, University of Wisconsin, United States
• Priyesh T. Thakkar, DO, MBA, FASN, Regional Nephrology Associates, United States
• Santosh Varughese, MD, Christian Medical College, India
• Aiyu Zhao, MD, Syracuse Veterans Affairs Medical Center, United States

Program Mission and Objectives

nephSAP® provides a learning vehicle for physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology to renew and refresh their clinical knowledge, diagnostic, and therapeutic skills. This enduring material provides learners challenging, clinically-oriented questions based on case vignettes, detailed learning objectives, a series of articles that review recent publications, and an editorial on an important and evolving topic. This combination of materials enables learners to rigorously assess their strengths and weaknesses in the broad domain of nephrology.

Target Audience

Physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology.

Accreditation Statement

In support of improving patient care, the American Society of Nephrology is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

AMA Credit Designation Statement – Physicians: The American Society of Nephrology designates this internet activity (enduring material) for a maximum of 10.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ANCC Credit Designation Statement – Nurses: This CE activity is approved for 10.00 ANCC contact hours.

ACPE Credit Designation Statement – Pharmacists: This CE activity is approved for 10.00 pharmacy contact hours.

AAPA/NCCPA Credit Designation Statement – Physician Assistants: Physician Assistants may receive a maximum of 10.00 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 Credits™ from organizations accredited by ACCME or a recognized state medical society.

ABIM MOC Statement

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to Joint Accreditation for the purpose of granting ABIM MOC credit. MOC points will be applied to only those ABIM candidates who have enrolled in the MOC program. It is your responsibility to complete the ABIM MOC enrollment process.

Original Release Date: September 2022

CME/MOC Termination Date: August 31, 2024

Examination Available Online: On or before September 30, 2022

Estimated Time for Completion: 10 hours 

Self-Assessment Examination

• Answers with explanations are provided with a passing score after the first and/or second attempt
• This issue will be archived September 1, 2024, and answers with explanations will be posted on the ASN website

Method of Participation

• Read the entire issue that is supplemented by original articles in the reference lists.
• Complete the online self-assessment examination.
• Each participant is allowed two attempts to pass the examination (75% correct) for CME and MOC.
• Upon completion, review your score and incorrect answers and print your certificate.

Activity Evaluation, CE, and MOC

• Go to ASN eLEARNING CENTER (education.asn-online.org)
• Select MY ACTIVITIES from the left-hand navigation.
• Select the corresponding issue.
• Read all information on the Overview screen.
• Follow the onscreen instructions to:
  • Complete the Exam (i.e., post test),
  • Complete the Evaluation,
  • Claim credit/MOC, and
    • IMPORTANT: select the credit type that corresponds with your designation, and
  • Print a Certificate

Your ASN Transcript is available on the ASN website:

• Go to the ASN website and log in to your ASN Profile page
• Select the CME/CE Transcript tab
• View credits claimed or print a certificate with continuing education information for completed learning activities