Arterial blood pressure

DR.KARTHIK.S.,M D.
Assistant professor
DEPT OF PHYSIOLOGY AND
BIOCHEMISTRY
 Arterial blood pressure
DEFINITIONS
• It is defined as the lateral pressure exerted by the column of
blood on wall of arteries.
• The pressure is exerted when blood flows through the arteries.
• which is expressed in four terms:
1. Systolic blood pressure
2. Diastolic blood pressure
3. Pulse pressure
4. Mean arterial blood pressure.
 „
SYSTOLIC BLOOD PRESSURE

It is defined as the maximum pressure exerted in

the arteries during systole of heart.
Normal systolic pressure: 120 mm Hg (110 mm
Hg to 140 mm Hg).
 DIASTOLIC BLOOD PRESSURE

It is defined as the minimum pressure exerted in

the arteries during diastole of heart.
Normal diastolic pressure: 80 mm Hg (60 mm
Hg to 80 mm Hg).„
 PULSE PRESSURE

Pulse pressure is the difference between the

systolic pressure and diastolic pressure.
Normal pulse pressure: 40 mm Hg (120 – 80 = 40).
 MEAN ARTERIAL BLOOD PRESSURE

• Mean arterial blood pressure is the diastolic pressure

plus one third of pulse pressure.
• Normal mean arterial pressure: 93 mm Hg Formula :
• Mean arterial blood pressure =
- Diastolic pressure + 1/3 of pulse pressure
- 80 + 40/3 = 93.3 mm Hg
 PHYSIOLOGICAL VARIATIONS

1. Age
Arterial blood pressure
increases as age advances.
Systolic pressure in different Diastolic pressure in different
age age
• Newborn : 70 mm Hg • Newborn : 40 mm Hg
• After 1 month : 85 mm Hg • After 1 month : 45 mm Hg
• After 6 month : 90 mm Hg • After 6 month : 50 mm Hg
• After 1 year : 95 mm Hg • After 1 year : 55 mm Hg
• At puberty : 120 mm Hg • At puberty : 80 mm Hg
• At 50 years : 140 mm Hg • At 50 years : 85 mm Hg
• At 70 years : 160 mm Hg • At 70 years : 90 mm Hg
• At 80 years : 180 mm Hg • At 80 years : 95 mm Hg
2. Sex
In females, up to the period of menopause, arterial
pressure is 5 mm Hg, less than in males of same age. After
menopause, the pressure in females becomes equal to that in
males of same age.
3. Body Built
Pressure is more in obese persons than in lean persons.
4. Diurnal Variation
In early morning, the pressure is slightly low. It gradually
increases and reaches the maximum at noon. It becomes low in
evening.
5. After Meals
Increased for few hours after meals due to
increase in cardiac output.
6. During Sleep
Reduced up to 15 to 20 mm Hg during deep
sleep. it increases slightly during sleep associated with
dreams.
7. Emotional Conditions
During excitement or anxiety, the blood pressure
is increased due to release of adrenaline.
8. After Exercise
After moderate exercise, systolic pressure increases
by 20 to 30 mm Hg above the basal level due to increase in
rate and force of contraction and stroke volume. Normally,
diastolic pressure is not affected by moderate exercise. It is
because, the diastolic pressure depends upon peripheral
resistance, which is not altered by moderate exercise.
After severe muscular exercise, systolic pressure rises
by 40 to 50 mm Hg above the basal level. But, the diastolic
pressure reduces because the peripheral resistance decreases
in severe muscular exercise.
 PATHOLOGICAL VARIATIONS

Pathological variations of arterial blood pressure are

hypertension and hypotension.
• Hypertension:
increase In systemic arterial blood pressure is
known as hypertension. Systolic above 150 mm of hg
and diastolic above 90 mm of hg, its consider as
hypertension. If there increase only in systolic pressure
is called systolic hypertension
• Hypotension:
low blood pressure is called hypotension. When
the systolic pressure is less than 90 mm of hg
 Determination of arterial blood
pressure - FACTORS MAINTAINING
ARTERIAL BLOOD PRESSURE
Arterial blood pressure is Arterial blood pressure is
directly proportional to inversely proportional to
1. Cardiac output 1. Elasticity of blood vessel
2. Heart rate 2. Diameter of blood vessel
3. Peripheral resistance
4. Blood volume
5. Venous return
6. Velocity of blood flow
7. Viscosity of blood
 Regulation of arterial blood
pressure
Body has 4 regulatory mechanism to maintain the blood
pressure with in normal limits
NERVOUS MECHANISM FOR REGULATION OF
BLOOD PRESSURE – SHORT-TERM
REGULATION
Nervous regulation is rapid among all the mechanisms.
When the pressure is altered, nervous system brings the pressure
back to normal within few minutes. The nervous mechanism
regulating the arterial blood pressure operates through the
vasomotor system
 Vasomotor System
Includes three components:
1. Vasomotor center
2. Vasoconstrictor fibers
3. Vasodilator fibers.
„
VASOMOTOR CENTER
Vasomotor center is bilaterally situated in the reticular
formation of medulla oblongata and the lower part of the pons.
Vasomotor center consists of three areas:
i. Vasoconstrictor area
ii. Vasodilator area
iii. Sensory area.
i. Vasoconstrictor Area or pressor area.
It forms the lateral portion of vasomotor center. And
sends impulses to blood vessels through sympathetic
vasoconstrictor fibers leads to vasoconstriction and rise in
arterial blood pressure. Also concerned with acceleration of heart
rate
ii. Vasodilator Area or depressor area.
It forms the medial portion of vasomotor center. And
suppresses the vasoconstrictor area and causes vasodilatation. It
is also concerned with cardioinhibition
iii. Sensory Area
Sensory area is in the nucleus of tractus solitarius, which
is situated in postero lateral part of medulla and pons. This area
receives sensory impulses via glossopharyngeal and vagal
nerves from the periphery, particularly from the baroreceptors.
Sensory area in turn, controls the vasoconstrictor and vasodilator
areas.
VASOCONSTRICTOR FIBERS
which is belong to the sympathetic division of
autonomic nervous system. Cause vasoconstriction by
the release of neurotransmitter substance,
noradrenaline.
Noradrenaline acts through alpha receptors of
smooth muscle fibers in blood vessels. Vasoconstrictor
fibers play major role than the vasodilator fibers in the
regulation of blood pressure.
VASODILATOR FIBERS
Three types:
i. Parasympathetic vasodilator fibers
ii. Sympathetic vasodilator fibers
iii. Antidromic vasodilator fibers.
i. Parasympathetic Vasodilator Fibers
Cause dilatation of blood vessels by releasing
acetylcholine.
ii. Sympathetic Vasodilator Fibers
Some of the sympathetic fibers cause vasodilatation in
certain areas, by secreting acetylcholine. Such fibers are called
sympathetic vasodilator or sympathetic cholinergic fibers
Sympathetic cholinergic fibers, which supply the blood vessels of
skeletal muscles, are important in increasing the blood flow to
muscles by vasodilatation, during conditions like exercise
iii. Antidromic Vasodilator Fibers
Normally, the impulses produced by a cutaneous receptor
pass through sensory nerve fibers. But, some of these impulses
pass through the other branches of axon in opposite direction and
reach the blood vessels supplied by these branches.
These impulses now dilate the blood vessels. It is called
the antidromic or axon reflex and the nerve fibers are called
antidromic vasodilator fibers
 MECHANISM OF ACTION OF VASOMOTOR CENTER IN THE REGULATION OF
BLOOD PRESSURE

Vasomotor center regulates the arterial blood pressure by

causing vasoconstriction or vasodilatation. However, its actions
depend upon the impulses it receives from other structures such
as baroreceptors, chemoreceptors, higher centers and respiratory
centers. Among these structures, baroreceptors and
chemoreceptors play a major role in the short term regulation of
blood pressure.
 Baroreceptor Mechanism

Baroreceptors give response to change in blood

pressure. Baroreceptors are also called pressoreceptors.
Situation
Baroreceptors are situated in the carotid sinus
and wall of the aorta
Nerve supply to baroreceptors and
chemoreceptors
Carotid baroreceptors are supplied by Hering nerve,
which is the branch of glossopharyngeal (IX cranial) nerve.
Aortic baroreceptors are supplied by aortic nerve, which
is a branch of vagus (X cranial) nerve
 Chemoreceptor Mechanism

Chemoreceptors are giving response to change in

chemical constituents of blood. Peripheral
chemoreceptors influence the vasomotor center.
Situation
Peripheral chemoreceptors are situated in the
carotid body and aortic body
Nerve Supply
Chemoreceptors in the carotid body are supplied by
Hering nerve, which is the branch of glossopharyngeal nerve.
Chemoreceptors in the aortic body are supplied by aortic
nerve which is the branch of vagus nerve
Function
When there is hypoxia, hypercapnea and increased
hydrogen ions concentration in the blood, the chemoreceptors are
stimulated and inhibitory impulses are sent to vasodilator area.
Vagal tone decreases and heart rate increases. Chemoreceptors
play a major role in maintaining respiration than the heart rate.
Higher Centers
Vasomotor center is also controlled by the impulses from
the two higher centers in the brain.
i. Cerebral cortex (Area 13)
it is concerned with emotional reactions. During
emotional conditions, this area sends impulses to vasomotor
center. Vasomotor center is activated, the vasomotor tone is
increased and the pressure rises.
ii. Hypothalamus
Stimulation of posterior and lateral nuclei of
hypothalamus causes vasoconstriction and increase in blood
pressure. Stimulation of preoptic area causes vasodilatation and
decrease in blood pressure. Impulses from hypothalamus are
mediated via vasomotor center.
4. Respiratory Centers
During the beginning of expiration, arterial blood
pressure increases slightly, i.e. by 4 to 6 mm Hg. It decreases
during later part of expiration and during inspiration because of
two factors:
i. Radiation of impulses from respiratory centers towards
vasomotor center at different phases of respiratory cycle
ii. Pressure changes in thoracic cavity, leading to alteration of
venous return and cardiac output.
 RENAL MECHANISM FOR REGULATION OF BLOOD PRESSURE – LONG-TERM
REGULATION

Kidneys play an important role in the long term

regulation of arterial blood pressure. When blood pressure alters
slowly in several days/months/years, the nervous mechanism
adapts to the altered pressure and looses the sensitivity for the
changes. It cannot regulate the pressure any more. In such
conditions, the renal mechanism operates efficiently to regulate
the blood pressure. Therefore, it is called long term regulation.
• Kidneys regulate arterial blood pressure by two ways:
1. By regulation of ECF volume
2. Through renin angiotensin mechanism.
 BY REGULATION OF EXTRACELLULAR
FLUID VOLUME

When the blood pressure increases, kidneys excrete large

amounts of water and salt, sodium, which reduce the ECF and
blood volume and bring the pressure back to normal level by
means of pressure diuresis
Even a slight increase in blood pressure doubles the water
excretion. Elevated blood pressure also leads to sodium
excretion, which is called pressure natriuresis
When blood pressure decreases, the reabsorption of water
from renal tubules is increased. This in turn, increases ECF
volume, blood volume and cardiac output, resulting in restoration
of blood pressure.
BY Renin angiotensin mechanism
Actions of Angiotensin II
When blood pressure and ECF volume decrease,
renin secretion from kidneys is increased. It converts
angiotensinogen into angiotensin I. This is converted
into angiotensin II by ACE angiotensin converting
enzyme).
Angiotensin II acts in two ways to restore the blood
pressure:
i. Constriction of arterioles so that the peripheral resistance is
increased and blood pressure rises. Also constriction of afferent
arterioles in kidneys, so that glomerular filtration reduces. This
results in retention of water and salts, increases ECF volume to
normal level. This in turn increases the blood pressure to normal
level.
ii. Simultaneously, angiotensin II stimulates the adrenal cortex to
secrete aldosterone. This hormone increases reabsorption of
sodium from renal tubules. Sodium reabsorption is followed by
water reabsorption, resulting in increased
 Hormonal mechanism for
regulation of BP
Hormones which increase Hormones which decrease arterial
blood pressure
arterial blood pressure
1. Vasoactive intestinal polypeptide
1. Adrenaline* (VIP)
2. Noradrenaline 2. Bradykinin
3. Prostaglandin
3. Thyroxine*
4. Histamine
4. Aldosterone 5. Acetylcholine
5. Vasopressin 6. Atrial natriuretic peptide
6. Angiotensin 7. Brain natriuretic peptide
Adrenaline and thyroxine increase systolic pressure but decrease
7. Serotonin
diastolic pressure.
 Applied physiology
Pathological variations of arterial blood pressure:
A. Hypertension
B. Hypotension.
„HYPERTENSION
Defined as the persistent high blood pressure.
when the systolic pressure above 150 mm Hg and diastolic
pressure 90 mm Hg, it is considered as hypertension.
If there is increase only in systolic pressure, it is called
systolic hypertension
Types of Hypertension
1. Primary hypertension or essential hypertension
2. Secondary hypertension.
Primary Hypertension or Essential Hypertension
Its the elevated blood pressure in the absence of any
underlying disease. It is also called essential hypertension.
Arterial blood pressure is increased because of increased
peripheral resistance, which occurs due to some unknown cause.

Primary hypertension is of two types:

i. Benign hypertension
ii. Malignant hypertension.
Benign hypertension
which does not cause any problem. It is defined as the
essential hypertension that runs a relatively long and
symptomless course. In early stages of this condition, increase
systolic pressure of 200 mm Hg and the diastolic pressure of
about 100 mm Hg. However, in resting conditions and sleep, the
blood pressure returns to normal level. Later, there is a further
increase in blood pressure and it does not come back to normal
level in resting conditions. Persistent increase in pressure over
the years causes development of vascular, cardiac or renal
diseases.
Malignant hypertension
Malignant hypertension is a severe form of hypertension
with a rapid course leading to progressive cardiac and renal
diseases. It is also called accelerated hypertension. In this case,
the blood pressure is elevated to a great extent. Systolic pressure
rises to about 250 mm Hg and diastolic pressure rises to 150 mm
Hg. It is always developed due to the combined effects of
primary and secondary hypertension. Malignant hypertension
cause severe damage of tunica intima of small blood vessels and
organs like eye (retina), heart, brain and kidneys. It is a fatal
disease, since it causes death within few years.
Secondary Hypertension
Its the high blood pressure due to some underlying disorders. The
different forms of secondary hypertension are:
Cardiovascular hypertension
a. Atherosclerosis: Hardening of blood vessels due to fat
deposition
b. Coarctation of aorta: Narrowing of aorta.
Endocrine hypertension
a. Pheochromocytoma: Tumor in adrenal medulla,
resulting in excess secretion of catecholamines
b. Hyperaldosteronism: Excess secretion of aldosterone
from adrenal cortex
c. Cushing syndrome: Excess secretion of glucocorticoids
from adrenal cortex.
Renal hypertension
a. Stenosis of renal arteries
b. Tumor of juxtaglomerular cells, leading to excess production of
angiotensin II
c. Glomerulonephritis.
Neurogenic hypertension
a. Increased intracranial pressure
b. Lesion in tractus solitarius
c. Sectioning of nerve fibers from carotid sinus.
Hypertension during pregnancy
Some pregnant women develop hypertension because of toxemia of
pregnancy. Arterial blood pressure is elevated by the low glomerular filtration
rate and retention of sodium and water. It may be because of some
autoimmune processes during pregnancy or release of some vasoconstrictor
agents from placenta or due to the excessive secretion of hormones causing
rise in blood pressure. Hypertension is associated with convulsions in
eclampsia.
Treatment of Hypertension
Secondary hypertension is cured by treating the
disease causing hypertension.
Primary hypertension can be controlled but
cannot be cured.
 HYPOTENSION

Hypotension is the low blood pressure. When the systolic

pressure is less than 90 mm Hg, it is considered
as hypotension.
Types
1. Primary hypotension
2. Secondary hypotension.
1. Primary hypotension
Primary hypotension is the low blood pressure that
develops in the absence of any underlying disease and develops
due to some unknown cause. It is also called essential
hypotension. Frequent fatigue and weakness are the common
symptoms of this condition. However, the persons with primary
hypotension are not easily susceptible to heart or renal disorders.
2. Secondary hypotension
Secondary hypotension is the hypotension that occurs due
to some underlying diseases. Diseases, which cause hypotension
are:
i. Myocardial infarction
ii. Hypoactivity of pituitary gland
iii. Hypoactivity of adrenal glands
iv. Tuberculosis
v. Nervous disorders.
Thank
you