Many patients with higher-level SCIs have a lower baseline BP. If they have what’s commonly defined as a “normal” BP, this actually may represent early AD. In some cases, elevated BP reaches levels of clinical emergency. Use rapid interventions, such as sitting the patient upright to induce orthostasis (if possible) and administering fast-acting antihypertensive agents (such as nifedipine) if ordered, to lower BP as the offending stimulus is identified and eliminated. The most common culprits in AD are a full bowel and distended bladder.