Consistent and Long-Term Control of Blood Pressure is

Determined by The Renin-Angiotensin System

LEARNING OBJECTIVE

Describe the long-term renal regulation of blood pressure

KEY POINTS

When blood volume is low renin, excreted by the kidneys, stimulates production of angiotensin I,
which is converted into angiotensin II, which has many effects, including increase in blood pressure due to its
vasoconstrictive properties.
The cells that excrete renin are called juxtaglomerular cells. When blood volume is low,
juxtaglomerular cells in the kidneys secrete renin directly into circulation. Plasma renin then carries out the
conversion of angiotensinogen released by the liver to angiotensin I.
Aldosterone secretion from the adrenal cortex is induced by angiotensin II and causes the tubules of
the kidneys to increase the reabsorption of sodium and water into the blood, thereby increasing blood volume and
blood pressure.

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TERMS

juxtaglomerular cells
The juxtaglomerular cells (JG cells, or granular cells) are cells in the kidney that synthesize, store, and
secrete the enzyme renin.

aldosterone
A mineralocorticoid hormone, secreted by the adrenal cortex, that regulates the balance of sodium and
potassium in the body.

adrenal cortex
The outer portion of the adrenal glands that produces hormones essential to homeostasis.
There are many physical factors that influence arterial pressure. Each of these may in turn be influenced by
physiological factors such as diet, exercise, disease, drugs or alcohol, stress, obesity, and so-forth.

Some physical factors are: Rate of pumping. In the circulatory system, this rate is
called heart rate, the rate at which blood (the fluid) is pumped by the heart. The volume of blood flow from
the heart is called the cardiac output which is the heart rate (the rate of contraction) multiplied by the stroke
volume (the amount of blood pumped out from the heart with each contraction). The higher the heart rate, the
higher themean arterial pressure, assuming no reduction in stroke volume or central venous return.
Volume of fluid or blood volume is the amount of blood that is present in the body. The more blood present in
the body, the higher the rate of blood return to the heart and the resulting cardiac output. There is some
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relationship between dietary salt intake and increased blood volume, potentially resulting in higher arterial
pressure, although this varies with the individual and is highly dependent on autonomic nervous
system response and the renin-angiotensin system. Resistance. In the circulatory system, this is the
resistance of the blood vessels. The higher the resistance, the higher the arterial pressure upstream from the
resistance to blood flow. Resistance is related to vessel radius (the larger the radius, the lower the resistance),
vessel length (the longer the vessel, the higher the resistance), blood viscosity, as well as the smoothness of the
blood vessel walls. Smoothness is reduced by the buildup of fatty deposits on the arterial walls. Substances
called vasoconstrictors can reduce the size of blood vessels, thereby increasing blood pressure. Vasodilators
(such as nitroglycerin) increase the size of blood vessels, thereby decreasing arterial pressure. Resistance, and
its relation to volumetric flow rate (Q) and pressure difference between the two ends of a vessel are described
by Poiseuille's Law.

Viscosity is the thickness of the fluid. If the blood gets thicker, the result is an increase in arterial
pressure. Certain medical conditions can change the viscosity of the blood. For instance, anemia (low red
blood cell concentration), reduces viscosity, whereas increased red blood cell concentration increases
viscosity. It had been thought that aspirin and related "blood thinner" drugs decreased the viscosity of blood,
but instead studies found that they act by reducing the tendency of the blood to clot. In practice, each
individual's autonomic nervous system responds to and regulates all these interacting factors so that, although
the above issues are important, the actual arterial pressure response of a given individual varies widely because
of both split-second and slow-moving responses of the nervous system and end organs. These responses are
very effective in changing the variables and resulting blood pressure from moment to moment.

The reninangiotensin system (RAS) or the reninangiotensinaldosterone system (RAAS) is

a hormone system that regulates blood pressure and water (fluid) balance. When blood volume is low,
juxtaglomerular cells in the kidneys secrete renin directly into circulation. Plasma renin then carries out the
conversion of angiotensinogen released by the liver to angiotensin I. Angiotensin I is subsequently converted to
angiotensin II by the enzyme angiotensin converting enzyme found in the lungs. Angiotensin II is a potent
vaso-active peptide that causes blood vessels to constrict, resulting in increased blood pressure. Angiotensin
II also stimulates the secretion of the hormone aldosterone from the adrenal cortex. Aldosterone causes the
tubules of the kidneys to increase the reabsorption of sodium and water into the blood. This increases the
volume of fluid in the body, which also increases blood pressure. If the reninangiotensinaldosterone system
is too active, blood pressure will be too high. There are many drugs that interrupt different steps in this system
to lower blood pressure. These drugs are one of the main ways to control high blood pressure (hypertension),
heart failure, kidney failure, and harmful effects of diabetes.

It is believed that angiotensin I may have some minor activity, but angiotensin II is the major bio-active
product. Angiotensin II has a variety of effects on the body: throughout the body, it is a potent vasoconstrictor
of arterioles.

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Source: Boundless. Long-Term Renal Regulation. Boundless Anatomy and Physiology. Boundless, 21 Jul. 2015.
Retrieved 21 Apr. 2016 from https://www.boundless.com/physiology/textbooks/boundless-anatomy-and-physiologytextbook/cardiovascular-system-blood-vessels-19/control-of-blood-pressure-184/long-term-renal-regulation-914-3348/