Dr.P.J.

Samuel
Professor, Dept. of Physiology
 Definition of Blood Pressure(BP)
 Significance of (BP); other terms
 Recording BP
 Factors maintaining BP
 Physiological Variations in Arterial BP
 Regulation of Arterial BP
 Disorders
 Lateral pressure exerted by the moving
column of blood on the walls of vessels

Lateral
pressure

End-on
pressure
 To ensure blood flow to various organs &
maintain the perfusion of organs

 Formation of Urine

 For formation of tissue fluids & lymph.

 Arterial B.P is not steady but
fluctuates during cardiac cycle
◦ reaches maximum during systole &
minimum during diastole
 If BP in the blood vessels
corresponded to left ventricular
pressures, then blood would flow
only during ventricular contraction
… then there would be no blood
supply to the organs while the
ventricle relaxed.

But fortunately the blood flow is

maintained throughout … and this is
how it happens …
 Maximum pressure recorded during the
cardiac cycle
 Normal Value: 100-140mm Hg
 Depends
◦ mainly on cardiac output
◦ compliance of the arteries
 Minimum pressure recorded during cardiac cycle
 60-90 mm Hg
 Depends primarily on peripheral resistance
(diameter of the vessel & blood viscosity)

1. It represents a constant
load on the arterial walls
with little or no
fluctuation at all.

2. It is an index to the
peripheral resistance and
decides the filling of the
Coronary system.
 Difference between systolic and diastolic
blood pressure
 20-50 mm Hg
 Significance: maintains the normal pulsatile
nature of flow of blood
 An index of Cardiac Output
 Average pressure recorded during cardiac cycle
• MAP = Diastolic pressure + 1/3 PP (geometric
mean – because systole 0.3 sec but diastole 0.5 sec)
 Is the pressure that helps in forward movement of
blood in the lumen of blood vessel – perfusion pr.
 75-105 mm Hg
 Direct method
1. Glass manometer
2. Pressure transducer

Reverend Steven Hale’s

first direct recording of the
arterial blood pressure of
his own mare
Indirect method
Using a sphygmomanometer
Principle : Balancing the air pressure against
the blood pressure in the brachial artery.

1. Palpatory Method
2. Oscillatory Method
3. Auscultatory Method
 Palpate radial pulse.
 Inflate the cuff & raise
the pressure till pulse
disappears.
 Note the pressure-SBP
 Raise the pressure by
about 10 mmHg
 Deflate the cuff so
pressure falls slowly
 Note the pressure at
which the pulse
reappears- SBP
 Point of disappearance
/appearance is the
systolic pressure.
1. We will have a rough idea about SBP.
2. Auscultatory gap can be avoided.

Disadvantage
1. DBP cannot be determined by this method.
2. SBP is 2-4 mm Hg less than when
measured by Auscultatory method.
 Diaphragm of stethoscope placed at
bend of elbow over brachial artery
 Cuff inflated 20mmHg above systolic
pressure as per palpatory method
 Pressure is slowly reduced
 As pressure is falling - clear tapping
sound is heard & it undergoes
changes & finally disappears.
 Pressure at which the sound first
appears is -systolic pressure
 Pressure at which sound disappears
is - diastolic pressure.
 These sounds -Korotkoff sounds.
The
Basis Korotkoff
Sounds
SBP
120 mm Hg Tapping sound 1

110 mm Hg Murmurish 2

95 mm Hg Banging sound 3

85 mm Hg Muffling sound 4

80 mm Hg No sound 5

DBP-
 A clear tapping sound appears which
becomes louder for about 5-10mmHg.
 The sound then becomes murmurish for
about 10-15 mmHg.
 Next the sound becomes clearer & louder
for the next 10- 15mmHg fall.
 The sound then become muffled.
 Finally the sound disappears.
Advantages
 Both Systolic & Diastolic pressure can be
recorded.
 Gives accurate value of Systolic Pressure.

 Disadvantage - Unless preceded by

palpatory method auscultatory gap is
missed.
1.Carotid atherosclerosis
2. Increased arterial stiffness in hypertensive patients
 In severe hypertensive patients - sound after
first appearance - may disappear for a
range of 20-50 mmHg - reappear again and
finally disappear at the level of Diastolic
pressure .
 The period of disappearance (temporary) is
called Auscultatory gap/silent gap.
 The reappearing sound may be taken as
systolic pressure which will be falsely low.
 So palpatory method should be done to
estimate systolic pressure & the cuff inflated
above this level during auscultatory method.
These may be considered as
1. Factors maintaining BP
2. Other factors affecting BP

 BP = C.O. x PR

 Factors affecting Cardiac output

 Factors affecting peripheral resistance
 C.O. = Stroke volume x Heart rate

 Factors affecting Preload

◦  Blood volume
◦  Venous tone
◦ Skeletal muscle pump
◦ Respiratory pump
◦  Atrial contraction
 Myocardial contractility

 Heart rate
 Diameter of Blood vessels
◦ Vasoconstriction -  PR -  BP

  Viscosity -  BP
◦ Viscosity  - polycythemia, hyperproteinemia,
decreased temperature
 Diurnal - Lower in morning &higher in evening.
 Age -  with age (By17yrs-normal adult level)
 Sex- Females before menopause lower (4-
6)Systolic than male. After menopause (4-6)
higher than male.
 Pregnancy: SBP -  ( blood volume);DBP -  (
peripheral resistance) ;Pulse pressure 
 Surface area- More in obese.
 Sleep – In relaxed state & during sleep BP tends
to fall. But in disturbed sleep BP 
 Respiration – Traube-Hering-Mayer waves
 Immediately after standing from lying down
posture there is pooling of blood in the legs-
 VR -  Co -  BP

 Rectified by Baroreceptors (via VM centre)

◦ Increased Diastolic pressure due to PR
◦ Systolic pressure is elevated slightly.

 Later due to decrease in Baroreceptor

discharge BP comes back to normal.
 In standing position due to gravity the
pressure in the vessel
◦ below heart level is 
◦ above the heart is 
 For every cm below or above the heart level
the BP  or  by 0.77mmHg

Climatic temperature.
a)Exposure to cold – vasoconstriction –
Increased PR – Increased BP
b) Exposure to hot temp – vasodialation-
Decreased PR – Decreased BP
Exercise
Effect depends on the severity of the
exercise, trained or untrained person etc.

Emotion
Sympathetic activity during fear worry - 
Systolic BP

Effect of Meals
Systolic pressure  lasting for few hrs
Diastolic pressure  or remains the same
 Regulation of Blood Pressure

Nervous Renal Hormonal Local

Mechanism Mechanism Mechanism Mechanism

By By By By Local
Vasomotor Regulation Vasocons- Vasocons-
Center and of ECF -trictor and -trictors and
Impulses Volume and Vasodilator Vasodilators
from renin – Hormones
Periphery angiotensin
mechanism
 SHORT-TERM CONTROL
(IN SEC – MIN)
 INTERMEDIATE-TERM CONTROL
(30 MIN – HOURS)
 LONG – TERM CONTROL
Within seconds or minutes

 CNS ISCHAEMIC RESPONSE

 BARORECEPTOR REFLEX

 CHEMORECEPTOR REFLEX
 Autonomic mechanism – Symp & Para symp
 Medullary control
 Hypothalamic control
 Cortical control
 Reflex regulation
 Parasympathetic control -  BP
◦ Systemic blood vessels – not supplied by
parasympathetic nerves
◦ Vagal stimulation- HR & CO-  BP
 Sympathetic control -  BP
◦ Noradrenalin – Vasoconstrictor
◦ Basal rate of tonic discharge –  Vascular tone
◦ Venoconstriction-  venous return
◦ Cardiac stimulation -  HR & Force of contraction
 Cardiovascular centres located in medulla
◦ Vasomotor centres
◦ Cardioinhibitory centres
 Baroreceptors – pressure receptors
 Receptor & Afferent nerve
◦ Carotid sinus – IX - glossopharyngeal
◦ Aortic sinus – X – Vagus
 Centre –medullary cardiovascular centres–
◦ VMC & CIC
 Efferent pathway
◦ Sympathetic – lat horn of spinal cord- innervates
heart & blood vessels
◦ Vagus nerve- innervates the heart
 Sinoaortic reflex/Pressure buffer system
 Stretch receptors located in the aortic arch
and carotid sinuses.
 Present in the adventitia of the vessel wall.
 They are myelinated nerve fibres.
 An  in pressure causes the walls of these
regions to stretch & stimulate these
receptors  frequency of APs.
 More sensitive to change in pressure.
 Baroreceptor reflex
 BP

Baroreceptor stimulation

Stimulation of Nucleus Tractus Solitarius
- +
VMC CIC
 
SNS Vagal Nerve


 Vagal tone
Blood vessel

 Heart 
Vasodilation (Bradycardia)

CO 
BP 
 Located in Carotid & Aortic Bodies
 Respond to changes in chemical composition
of blood ( PO2 - < 60mmHg)
  BP -  PO2 - stimulation of Chemo
receptors - stimulation of VMC -
Vasoconstriction -  PR -  BP
  BP falls

Blood flow to brain 

Hypoxia & Hypercapnia of VM centre

Stimulation of VM centre - vasoconstriction

 PR –  BP
  Intracranial pressure

Hypoxia & hypercapnia of VM centre

Vasoconstriction

Peripheral resistance

 BP
 Sinoaortic mechanism
60-180mmHg
 Chemoreceptor reflex
< 60mmHg (40-60mmHg)
 CNS ischemic response
< 40mmHg
Within minutes or hours

 STRESSRELAXATION OF
VASCULATURE

 FLUID – SHIFT THROUGH THE

CAPILLARY WALL
Onset – minutes to hours
When BP
 Hydrostatic pressure 
 Causes fluid to shift from intravascular space
to extra vascular space.
 Blood volume  & CO 
 So BP comes back to normal

When BP  fluid shifts from EC space to

Intravascular space & so blood volume  & BP 
  BP

Smooth muscles of the blood vessels relax in
response to stretching

 Vascular tone bringing the BP to normal
(VR - CO- normal BP)
  BP

Blood vessels contract

Maintain BP
(VR - CO –Normal BP)
Within hours to days … mainly regulate blood volume

 RENAL FLUID SHIFT

 HORMONES LIKE ADH, ANP, etc

 RENIN– ANGIOTENSIN –
ALDOSTERONE MECH.
  BP

 GFR

Water & electrolyte retention

BV - VR -  CO - BP
 Increased salt intake

Increased extracellular volume

Increased arterial pressure

Decreased renin and angiotensin

Decreased renal retention of salt and water

Return of extracellular volume almost to normal

Return of arterial pressure almost to normal

 HORMONES RAISING BP
◦ Adrenaline
◦ Noradrenaline
◦ Thyroxine
◦ Aldosterone
◦ Vasopressin
◦ Angiotensin
◦ Serotonin
 HORMONES DECREASING BP
◦ VIP
◦ Brady Kinin
◦ Prostaglandin
◦ Histamine
◦ Acetylcholine
◦ ANP
 These are myelinated nerve endings.
 Located in the atria of the heart. Type A
&B
 Receptors activated by increased venous
return.
 Stimulate reflex tachycardia.
 Inhibit ADH release.
 Promote secretion of ANP.
 Fall in BP
 Produced by the atria of the heart.
 Stretch of atria stimulates production of
ANP.
Antagonistic to aldosterone & angiotensin II.
◦ Promotes Na+ and H20 excretion in the urine by
the kidney.
◦ Promotes vasodilation.
A. Vasodilatos
7. Prostacyclin
1. EDRF
8. Adenosine
2. Bradykinin +
9. K
3. Histamine
10. Acidosis [ CO2]
4. ANP
11. Hypercapnia
5. VIP
12. Hypoxia
6. Substance P
13. Temperature
B. Vasoconstrictors
1. Endothelin-1
2. Angiotensin II
3. Norepinephrine
4. ADH
5. Serotonin
6. Thromboxane A2
7. Neuropeptide-Y
8. Cold
 Sustained elevation of Systolic pressure of
more than 140mmHg &/or diastolic
pressure of more than 90mmHg
 Types -
◦ Experimental Hypertension
◦ Clinical Hypertension
 Primary Hypertension
 Secondary hypertension
 Also called Essential hypertension.
 Cause not known.
 Risk factors - Heredity, obesity, mental
tension, smoking, sedentary life style.
 Features may be - CO, A-II
Sympathetic activity in kidney
 Secondary to a disease.
 Causes
Renal- Glomerulonephritis, Tumors of JG
cells
Endocrine- Cushing’s,
Hyperaldosteronism, pheochromocytoma
(tumor of adrenal medulla)
Others. Oral contraceptive, Polycythemia
 Chronic hypertension where patient
develop papilledema, cerebral symptoms &
renal failure.
 Without treatment it is fatal.
 Silent killer
 Patients are asymptomatic until
substantial vascular damage occurs.
◦ Atherosclerosis.
 Increases afterload
◦ Increases workload of the heart.
◦ Congestive heart failure.
 Damage cerebral blood vessels
◦ Cerebral vascular accident (stroke).
Modification of lifestyle:
• Cessation of smoking.
• Moderation in alcohol intake.
• Weight reduction.
• Programmed exercise.
• Reduction in salt (Na+) intake.
 Interference with renal blood flow -
Constriction of one renal artery, other
kidney removed (one clip , one kidney
Goldblatt hypertension)
 Constriction of renal artery other kidney
intact one clip two kidney Goldblatt
hypertension)
 Constriction of Aorta or both renal
arteries (two clip two kidney Goldblatt
Hypertension)
 Systolic below 90 mmHg
 Types
 Primary Hypotension- Cause not known
 Secondary –Due to underlying causes
like
Neurogenic shock, myocardial infarction,
Hemoragic shock etc
 Postural Hypotension- fall in BP when
person stands up from lying posture due
to dysfunction of ANS.
 Significance of Blood Pressure(BP)
 Definition of BP; other terms
 Recording BP
 Factors maintaining BP
 Physiological Variations in Arterial BP
 Regulation of Arterial BP
 Disorders
 Define Blood pressure. Give the normal values
of SBP, DBP,PP & MAP. List the regulation of
blood pressure and explain neural regulation
of blood pressure
 Renin – Angiotensin mechanism
 Cushing’s reflex
 Sino-aortic reflex
 Role of kidney in BP regulation
 Hypertension
 Hypotension
 Korotkoff’s sounds