MINARMA SIAGIAN
DEPARTMENT OF PHYSIOLOGY
Definitions
Components
Measurements
Physiology
of Blood Pressure
Regulation
Abnormalities in Blood Pressure
Conclusions
Force
per unit area exerted on the wall of
a blood vessel by its contained blood (
hydrostatic pressure)
Expressed in millimeters of mercury (mm Hg)
Measured in reference to systemic arterial BP
in large arteries near the heart
The
differences in BP within the vascular
system provide the driving force that
keeps blood moving from higher to lower
pressure areas (vis a tergo)
The pumping action of the heart generates
blood flow through the vessels along a
pressure gradient, always moving from higherto lower-pressure areas
Pressure results when flow is opposed by
resistance
Systemic pressure:
Is highest in the aorta
Declines throughout the length of the pathway
Is 0 mm Hg in the right atrium
The steepest change in blood pressure occurs
in the arterioles
Represents
the pressure of the blood
as it moves through the arterial
system
Cardiac output = HR x SV
Vascular resistance (VR)
Mean arterial pressure = CO x VR
Systolic
pressure: pressure at the
height of the pressure pulse
Diastolic pressure: the lowest
pressure
Pulse pressure: the difference
between systolic and diastolic pressure
Mean arterial pressure: the average
pressure in the arterial system during
ventricular contraction and relaxation
Arterial
BP reflects two factors of the
arteries close to the heart
Their elasticity (compliance or
distensibility)
The amount of blood forced into them at
any given time
Blood
pressure in elastic arteries near
the heart is pulsatile (BP rises and
falls)
Physical
Blood volume and the elastic properties
of the blood vessels
Physiologic
factors
Cardiac output
Peripheral vascular resistance
Medullary cardiac control
Baroreceptor reflex
center
Carotid
Aortic
Kidney: blood volume
Hypothalamus & Cortex:
etc.
stress, blushing,
The baroreceptor reflex: the response to increased blood pressure
Maintaining
blood pressure requires:
Cooperation of the heart, blood vessels,
and kidneys
Supervision of the brain
The
main factors influencing blood
pressure are:
Cardiac output (CO)
Peripheral resistance (PR)
Blood volume
Blood
Blood
pressure = CO x PR
pressure varies directly with CO,
PR, and blood volume
Cardiac
output is determined by venous
return and neural and hormonal controls
Resting heart rate is controlled by the
cardioinhibitory center via the vagus
nerves
Stroke volume is controlled by venous return
(end diastolic volume, or EDV)
Under
stress, the cardioacceleratory center
increases heart rate and stroke volume
The end systolic volume (ESV) decreases and
MAP increases
Short-term
regulation: corrects
temporary imbalances in blood
pressure
Neural mechanisms
Humoral mechanisms
Long-term
regulation: controls the
daily, weekly, and monthly
regulation of blood pressure
Renal mechanism
Neural
controls of peripheral resistance:
Alter blood distribution to respond to specific
demands
Maintain MAP by altering blood vessel
diameter
Neural
controls operate via reflex arcs
involving:
Baroreceptors
Vasomotor centers of the medulla and
vasomotor fibers
Vascular smooth muscle
Vasomotor
center a cluster of
sympathetic neurons in the medulla that
oversees changes in blood vessel diameter
Maintains blood vessel tone by innervating
smooth muscles of blood vessels, especially
arterioles
Cardiovascular
center vasomotor center
plus the cardiac centers that integrate
blood pressure control by altering cardiac
output and blood vessel diameter
Sympathetic
activity causes:
Vasoconstriction and a rise in blood
pressure if increased
Blood pressure to decline to basal levels
if decreased
Vasomotor
activity is modified by:
Baroreceptors (pressure-sensitive),
chemoreceptors (O2, CO2, and H+
sensitive), higher brain centers,
bloodborne chemicals, and hormones
Increased
blood pressure stimulates
the cardioinhibitory center to:
Increase vessel diameter
Decrease heart rate, cardiac output,
peripheral resistance, and blood
pressure
Declining
blood pressure stimulates
the cardioacceleratory center to:
Increase cardiac output and peripheral
resistance
Low
blood pressure also stimulates
the vasomotor center to constrict
blood vessels
Blood
pressure is regulated by
chemoreceptor reflexes sensitive to
oxygen and carbon dioxide
Prominent chemoreceptors are the carotid
and aortic bodies
Reflexes that regulate blood pressure are
integrated in the medulla
Higher brain centers (cortex and
hypothalamus) can modify BP via relays to
medullary centers
Adrenal
medulla hormones
norepinephrine and epinephrine increase
blood pressure
Antidiuretic hormone (ADH) causes
intense vasoconstriction in cases of
extremely low BP
Angiotensin II kidney release of renin
generates angiotensin II, which causes
intense vasoconstriction
Endothelium-derived factors endothelin
and prostaglandin-derived growth factor
(PDGF) are both vasoconstrictors
Atrial
natriuretic peptide (ANP)
causes blood volume and pressure to
decline
Nitric oxide (NO) has brief but potent
vasodilator effects
Inflammatory chemicals histamine,
prostacyclin, and kinins are potent
vasodilators
Alcohol causes BP to drop by
inhibiting ADH
Long-term
mechanisms control BP by
altering blood volume
Baroreceptors adapt to chronic high
or low blood pressure
Increased BP stimulates the kidneys to
eliminate water, thus reducing BP
Decreased BP stimulates the kidneys to
increase blood volume and BP
Kidneys
act directly and indirectly to
maintain long-term blood pressure
Direct renal mechanism alters blood
volume
Indirect renal mechanism involves the
renin-angiotensin mechanism
Declining BP causes the release of renin, which
triggers the release of angiotensin II
Angiotensin II is a potent vasoconstrictor that
stimulates aldosterone secretion
Aldosterone enhances renal reabsorption and
stimulates ADH release
Efficiency
of the circulation can be
assessed by taking pulse and blood
pressure measurements
Vital signs pulse and blood pressure,
along with respiratory rate and body
temperature
Pulse pressure wave caused by the
expansion and recoil of elastic arteries
Radial pulse (taken on the radial artery at
the wrist) is routinely used
Varies with health, body position, and
activity
Systemic
arterial BP is measured
indirectly with the auscultatory
method
A sphygmomanometer is placed on the
arm superior to the elbow
Pressure is increased in the cuff until it is
greater than systolic pressure in the
brachial artery
Pressure is released slowly and the
examiner listens with a stethoscope
The first sound heard is recorded as the
systolic pressure
The pressure when sound disappears is
recorded as the diastolic pressure
Phase
I: marked by the first tapping
sound, which gradually increase in intensity
Phase II: period in which a murmur or
swishing sound is heard
Phase III: period during which sounds are
crisper and greater in intensity
Phase IV: period marked by distinct abrupt
muffling or by a soft blowing sound
Phase V: point at which sounds disappear
Blood
pressure cycles over a 24-hour
period
BP peaks in the morning due to waxing
and waning levels of retinoic acid
Extrinsic factors such as age, sex,
weight, race, mood, posture,
socioeconomic status, and physical
activity may also cause BP to vary
Hypotension
low BP in which systolic
pressure is below 100 mm Hg
Hypertension condition of sustained
elevated arterial pressure of 140/90 or
higher
Transient elevations are normal and can be
caused by fever, physical exertion, and
emotional upset
Chronic elevation is a major cause of heart
failure, vascular disease, renal failure, and
stroke
Orthostatic
hypotension temporary
low BP and dizziness when suddenly
rising from a sitting or reclining position
Chronic hypotension hint of poor
nutrition and warning sign for Addisons
disease
Acute hypotension important sign of
circulatory shock
Threat to patients undergoing surgery and
those in intensive care units
Systolic
pressure less than 120 mm
Hg and a diastolic pressure of less
than 80 mm Hg are normal.
Systolic pressures between 120 and
139 mm Hg and diastolic pressures
between 80 and 89 mm Hg are
considered prehypertensive.
A diagnosis of hypertension is made if
the systolic blood pressure is 140 mm
Hg or higher and the diastolic blood
pressure is 90 mm Hg or higher.
Hypertension
maybe transient or
persistent
Primary or essential hypertension risk
factors in primary hypertension include
diet, obesity, age, race, heredity, stress,
and smoking
Secondary hypertension due to
identifiable disorders, including
excessive renin secretion,
arteriosclerosis, and endocrine disorders
Blood Pressure (arterial):
Force per unit area exerted on the wall of a blood
vessel by its contained blood
Components:
Systolic/diastolic pressure (mmHg)
Measurement:
Sphygmomanometer
Korotkoff sounds
Blood Pressure Regulation:
Short-term neural, endocrine (humoral)
Long-term kidneys
Abnormalities in BP:
Hypotension
hypertension
