REGULATION OF ARTERIAL

BLOOD PRESSURE

Prof, M.M.Kardash
Supplemental Figures and Readings

Textbook of Medical Physiology

Guyton & Hall
10th Edition, 2000
Chapters 18 & 19

The Principles and Practice of Nephrology

2nd Edition,1995
Jacobson, Striker & Klahr
Chapter 57; “Normal Regulation of Arterial Pressure”
Vari & Navar
Figs. 57-2 & 57-3
OBJECTIVES

1. Describe the short - term mechanisms for blood pressure

regulation.

2. Compare and contrast the atrial and arterial systems (sensors,

afferents, efferents) for blood pressure regulation.

3. Explain why the arterial baroreflex cannot be responsible for

long-term regulation of arterial blood pressure.

4. Describe the importance of extracellular fluid volume in the

regulation of arterial pressure.

5. Describe the relationship between renal salt and water

excretion and arterial blood pressure (renal output curve).

6. Integrate the renal output curve with long-term blood pressure

regulation.
LECTURE OUTLINE
I. Short-Term Regulation of Blood Pressure
A. Atrial Pressure Reflex
1. Low (small changes) volume / pressure
2. Sensors – right atrium
3. Afferents / efferents (same as arterial baroreflex)
B. Arterial Baroreflex
1. Pressure
2. Sensors
3. Afferents
4. Relay
5. Efferents
6. Target organs – effects
7. Setpoint : maximum sensitivity
C. Other Pressure Regulators
1. Chemoreceptors
2. Cerebral Ischemia

II. Extracellular Volume – Blood Pressure Regulation

III. Long-Term Regulation of Blood Pressure

A. Renal Output Curve
B. Renin angiotensin aldosterone system
C. Renal output curve – salt and water intake
D. Increased arterial pressure – essential hypertension
CARDIOVASCULAR HEMODYNAMIC
RELATIONSHIPS

BP = CO x TPR
(Heart) (Vasculature)

CO = HR x SV

BP Blood pressure
CO Cardiac output
TPR Total peripheral resistance
HR Heart rate
SV Stroke volume
SHORT-TERM REGULATION OF
ARTERIAL PRESSURE

1. Atrial pressure / volume reflex

2. Arterial baroreflex

3. Other Pressure Regulators

 Chemoreceptors
 Carotid bodies
 MAP < 80 mmHg

 Cerebral Ischemia
 MAP < 60 mmHg
ATRIAL VOLUME / PRESSURE
RECEPTORS
Located in Right Atrium – vena cava
 Sense changes in venous return
“Low Volume Receptors”
 Small changes in volume/pressure
Afferents
 Vagus nerve * Before
Relay System - “vasomotor center” - Medulla
 NTS (nucleus tractus solatarius)
 NA (nucleus ambiguus)
 DN (dorsal motor nucleus)
Efferents
 Vagus
Sympatheics
*

 Preganglionic transmitter
(acetylcholine)
 Postganglionic transmitter
(norepinephrine)
Target Organs
 Heart (HR)
 Vascular smooth muscle (TPR)
 Kidney (urine output)
 Adrenal medulla (catecholamine
release, Epi, NE)
ARTERIAL BAROREFLEX
“REDUNDANT SYSTEM /
ATRIAL VOLUME SYSTEM

Sensors Located in arterial

system
*
 Sense changes in
arterial pressure
 Aortic Arch
 Carotid Sinus *
Afferents
 Vagus nerve – Aortic
arch
 Hering’s nerve &
Glossopharyngeal
nerve – carotid sinus
ARTERIAL BAROREFLEX
SETPOINT
 Maximum sensitivity (neural firing rate) is location
of normal arterial pressure
 Can reset at different levels
 Reflex is same but at higher pressure
ARTERIAL BAROREFLEX
Abnormal
baroreflex = Hypertension

NO!

 Resets
 Completely
 remove reflex –
Blood pressure
normal level but
fluctuates

(Fig. 18-9)
CARDIOVASCULAR HEMODYNAMIC
RELATIONSHIPS

BP = CO x TPR
(Heart) (Vasculature)

CO = HR x SV

BP Blood pressure
CO Cardiac output
TPR Total peripheral resistance
HR Heart rate
SV Stroke volume
BLOOD PRESSURE REGULATION –
BLOOD VOLUME / EXTRACELLULAR
FLUID VOLUME

1. Blood Volume – ECFV directly related

2. Blood volume can influence Cardiac

Output and therefore MAP

3. ECFV Balanced by:

 Dietary intake (salt and water)
 Renal excretion
 Modified by neurohumoral systems
 Arterial pressure direct effect

(Pressure natriuresis / diuresis)

BLOOD PRESSURE REGULATION –
BLOOD VOLUME / EXTRACELLULAR
FLUID VOLUME
LONG –TERM REGULATION OF
ARTERIAL PRESSURE
“Relationship of blood
“Pressure Natriuresis”
volume to blood
pressure”

Renal Output Curve

 BP directly affects
renal excretion
 No excretion
below 60 mmHg *
 Can be modulated by
hormones & disease
*

(Fig. 19-1)
LONG –TERM REGULATION OF
ARTERIAL PRESSURE
Renin Angiotensin
Aldosterone
System (RAAS)

Angiotensin II
 Aldosterone

 Vasoconstriction

(Aldosterone)

(Fig. 19-9)
LONG –TERM REGULATION OF
ARTERIAL PRESSURE

Renal Function
Curve Shifts

RAAS
LONG –TERM REGULATION OF
ARTERIAL PRESSURE

Renal Output
Curve vs
Salt and
Water Intake

Equilibrium point
at 100 mmHg

(Fig. 19-3)
LONG –TERM REGULATION OF
ARTERIAL PRESSURE

Two mechanisms
for essential
hypertension

1.Shift to right in renal

output curve (A)

2. Increase dietary
intake with NO shift
to left of renal
output curve (B)

(Fig. 19-4)