NPPA and hypertensive disorder: NPRA levels could be a response to low blood volume that is often noted after SCI and/or attributable to disruption of urinary regulation.38–41 Increased NPRA has been shown to be associated with downregulation of ANP.12 SCI often results in hypotension, which may result in an increase in NPRA, causing a significant decrease in blood pressure.40 Low levels of ANP are associated with hypertension, and the inverse is true that an increase in ANP leads to hypotension.42 Further research will be needed to better understand these multi-system effects.