NPPA and cardiac hypertrophy: Long term exposure to angiotensin II has been shown to induce hypertension, cardiac hypertrophy, activation of the hypertrophic fetal gene program atrial natriuretic peptide (ANP), B-type natriuretic peptide and alpha skeletal actin gene expression), increased expression of the pro-hypertrophic modulatory calcineurin inhibitor protein 1 (MCIP 1), and increased fibrosis with augmented procollagen 1 and 3 gene expression.