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
ASN is responsible for identifying and resolving all conflicts of interest prior to presenting any educational activity to learners to ensure that ASN CME activities promote quality and safety, are effective in improving medical practice, are based on valid content, and are independent of the control from commercial interests and free of bias. All faculty are instructed to provide balanced, scientifically rigorous and evidence-based presentations. In accordance with the disclosure policies of the Accreditation Council for Continuing Medical Education (ACCME), individuals who are in a position to control the content of an educational activity are required to disclose relationships with a commercial interest if (a) the relation is financial and occurred within the past 12 months; and (b) the individual had the opportunity to affect the content of continuing medical education with regard to that commercial interest. For this purpose, ASN consider the relationships of the person involved in the CME activity to include financial relationships of a spouse or partner. Peer reviewers are asked to abstain from reviewing topics if they have a conflict of interest. Disclosure information is made available to learners prior to the start of any ASN educational activity.
Alice M. Sheridan, MD—Current Employer: Brigham and Women’s Hospital
Martina M. McGrath, MBChB, FASN—Current Employer: Brigham and Women’s Hospital; VA Boston Medical Center
Suzanne Oparil, MD—Current Employer: University of Alabama at Birmingham; Consultancy Agreements: 98point6, Inc; Actelion Clinical Research Inc; George Clinical Pty Ltd/Actelion/Idorsia Pharmaceuticals, Ltd; Lundbeck; Novo Nordisk, Inc; Pfizer; ROX Medical, Inc; Research Funding: Actelion Pharmaceuticals/George Clinical (US site coordinator-resistant HTN survey); Bayer (site PI-diabetic kidney disease); NIH/NHLBI (Brigham and Women’s Hosp; Univ Wisconsin-Madison), NIH/NIAMS (Center of Research Translation; CORT); Novartis (site PI-resistant HTN; site PI-cognitive function/chronic HFpEF); ROX Medical Inc (Co-Inv-multicenter study/ROX coupler-HTN); Vascular Dynamics, Inc (Co-Inv-multi-center pivotal study/PMA for resistant HTN); Scientiﬁc Advisor/Membership: ROX Medical (ROX Control HTN 2 Study-US IDE Steering Committee Member; Editor-in-Chief, Current Hypertension Reports; Preventric Diagnostics, Inc - Chief MedicalOfficer; Independent contractor (CMO) development of hypertension and pulmonary health platform (BP monitoring); and CinCor Pharma Inc - Scientific Advisory Board (SAB) primary aldosteronism and hypertension
Jordana B. Cohen, MD, MSCE—Current Employer: University of Pennsylvania
Joseph C. Gigliotti, MS, PhD—Current Employer: Liberty University; Research Funding: Lantheus Medical Imaging (small equipment/material support); American Osteopathic Association, National Institutes of Health
Thu H. Le, MD—Current Employer: University of Rochester Medical Center; Consultancy Agreements: Relypsa; Research Funding: Renal Advisory Board, Astra Zeneca, NIH/NIDDK; Honoraria: Relypsa; Astra Zeneca; Scientiﬁc Advisor/Membership: American Journal of Physiology - Renal Physiology
Alicia A. McDonough, PhD—Current Employer: Keck School of Medicine of USC; Research Funding: National Institute of Health NIDDK; Honoraria: 2018 Renal Grand Rounds for University of Utah, 2019 Ulrich Hopfer lectureship for Case Western Reserve University; Scientiﬁc Advisor/Membership: American Journal of Physiology, Journal of the American Society of Nephrology, Kidney 360
Sandra J. Taler, MD—Current Employer: Mayo Clinic
Raymond R. Townsend, MD—Current Employer: University of Pennsylvania School of Medicine; Consultancy Agreements: Medtronic, Axio, ROX, Clarus; Research Funding: NIH; Scientiﬁc Advisor/Membership: Relypsa, Welch_Allyn; Other interests/relationships: Royalty - UpToDate contributor
Priya Vart, PhD, MPH—Current Employer: Radboud University; Scientiﬁc Advisor/Membership: Associate Editor for BMC Public Health
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
Mustafa Ahmad, MD, FASN, King Fahad Medical City, Riyadh, Saudi Arabia
Dario Roccatello, MD, San Giovanni Hospital and University of Torino, Torino, Italy
Helbert Rondon-Berrios, MD, FASN, University of Pittsburgh School of Medicine, Pittsburgh, PA
Ehab R. Saad, MD, FASN, Medical College of Wisconsin, Milwaukee, WI
Mark C. Saddler, MBChB, Mercy Regional Medical Center, Durango, CO
Neil Sanghani, MD, Vanderbilt University, Nashville, TN
Mohammad N. Saqib, MD, Lehigh Valley Hospital, Allentown, PA
Hitesh H. Shah, MD, Hofstra Northwell School of Medicine, Great Neck, NY
Michiko Shimada, MD, PhD, Hirosaki University, Hirosaki, Japan
Shayan Shirazian, MD, Winthrop-University Hospital State University of New York at Stony Brook, Mineola, NY
Arif Showkat, MD, FASN, University of Tennessee, Memphis, TN
Stephen M. Sozio, MD, Johns Hopkins University School of Medicine, Baltimore, MD
Ignatius Yun-Sang Tang, MD, FASN, University of Illinois at Chicago, Chicago, IL
Ahmad R. Tarakji, MD, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia
Hung-Bin Tsai, MD, National Taiwan University, Taipei, Taiwan
Katherine Twombley, MD, Medical University of South Carolina, Charleston, SC
Kausik Umanath, MD, Henry Ford Hospital, Detroit, MI
Puchimada M. Uthappa, MBBS, FASN, Columbia Asia Hospital, Mysore, Karnataka, India
Anthony M. Valeri, MD, Columbia University Medical Center, New York, NY
Allen W. Vander, MD, FASN, Kidney Center of South Louisiana, Thibodaux, LA
Jon R. Von Visger, MD, PhD, The Ohio State University, Columbus, OH
Nand K. Wadhwa, MD, Stony Brook University, Stony Brook, NY
Connie Wang, MD, Hennepin County Medical Center, Minneapolis, MN
Maura A. Watson, DO, Walter Reed National Military Medical Center, Bethesda, MD
Dawn Wolfgram, MD, Medical College of Wisconsin, Milwaukee, WI
Sri Yarlagadda, MBBS, University of Kansas Medical Center, Kansas City, KS
Brian Young, MD, Santa Clara Valley Medical Center, San Jose, CA
Mario Javier Zarama, MD, Kidney Specialists of Minnesota, Saint Paul, MN
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.
Physicians, scientists, advanced practitioners, nurses, pharmacists, and other health professionals working and training in the field of nephrology.
Accreditation and AMA Credit Designation Statements
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.
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.
ABIM MOC Statement
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 10.0MOCpoints 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 ACCME 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: May 2020
CME/MOC Termination Date: April 30, 2022
Examination Available Online: On or before May 29, 2020
Estimated Time for Completion: 10 hours
Answers with explanations are provided with a passing score after the first and/or second attempt
This issue will be archived in May 2022, 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, CME and MOC
Go to ASN CME Center (www.asn-online.org/cme), and log in.
Click the ENTER ACTIVITY button for this issue.
Read all frontmatter information.
Under the To Do List on the left navigation:
Click the Demographics & General Eval link, and enter your information.
If you are a physician:
Complete the Exam (required for CME/MOC). Physicians participating in this activity will be given two (2) attempts to pass the Exam (minimum performance level = 75% correct). Upon completion, you wil be able to access the Answers and Explanations for viewing. If you do not pass the Post Test within 2 attempts, you cannot claim CME/MOC for this activity.
Click the Claim Your CME Credits link, check the Attestation Statement box, and submit.
Click the Claim Your MOC Points link (for ABIM Diplomates only), check the Attestation Statement box, and submit.
Click the Print Your Certificate link.
For your complete ASN transcript, click the ASN CME Center banner, and click View/Print Transcript on the left.
Instructions to obtain American Board of Internal Medicine (ABIM) Maintenance of Certiﬁcation (MOC) Points
Each issue of nephSAP provides 10 MOC points. Respondents must meet the following criteria:
Be certiﬁed by ABIM in internal medicine and/or nephrology and enrolled in the ABIM–MOC program...
Enter your (ABIM) Candidate Number and Date of Birth prior to completing the examination.
Take the self-assessment examination within the timeframe speciﬁed in this issue of nephSAP.
Upon completion, click Claim Your MOC points, the MOC points submitted will match your CME credits claimed, check the Attestation Statement box and submit.
ABIM will notify you when MOC points have been added to your record.
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.
System Requirements Compatible Browser and Software
The nephSAP website (nephsap.org) is formatted for cross-browser functionality, and should display correctly in all currently supported web browsers. Individual nephSAP articles are available as dynamic HTML or in Portable Document Format (PDF), which requires Adobe Reader or comparable PDF viewing software.
The nephSAP website is designed for responsive display. This means the content display will respond to the device you use and to your devices screen resolution.
Medium or Combination of Media Used
The media used include content provided online as dynamic HTML or downloadable PDF, in addition to an online evaluation and self-assessment examination.
If you have difficulty viewing any of the pages, please refer to the nephSAP technical support page for possible solutions. If you continue having problems, contact ASN at firstname.lastname@example.org.