BLOOD PRESSURE(BP) AND

ITS REGULATION

D. KAMPOLO
 Introduction
• Arterial blood pressure is defined as the
lateral pressure exerted by the column of
blood on wall of arteries
• The pumping action of the heart generates
the flow
• Pressure occurs when the flow is met by
resistance from blood vessel walls
• BP is measured in millimeters of mercury
(mmHg)
 Introduction
• Blood pressure varies depending on the
condition of the heart and blood vessels
• It indicates heart and blood vessel health
• As blood flows through the systemic
circulation, pressure decreases progressively
because of the resistance to blood flow
• The largest decrease in pressure occurs across
the arterioles because they are the site of
highest resistance
Development of blood pressure
• The contraction of the ventricles ejects
blood into the pulmonary and systemic
arteries during systole
• A volume of blood equal to only about one-
third the stroke volume leaves the arteries
during systole
• The rest of the stroke volume remains in
the arteries during systole, distending
them and raising the arterial pressure
Development of blood pressure
• When ventricular contraction ends, the stretched
arterial walls recoil passively, like a stretched rubber
band being released, and blood continues to be
driven into the arterioles during diastole
• As blood leaves the arteries, the arterial volume
and therefore the arterial pressure slowly fall, but
the next ventricular contraction occurs while
there is still adequate blood in the arteries to stretch
them partially
• Therefore, the arterial pressure does not fall to zero
 Determinants of blood pressure
• The three most important variables
affecting blood pressure are the cardiac
rate, stroke volume (determined primarily
by the blood volume), and total peripheral
resistance
• An increase in any of these, if not
compensated for by a decrease in another
variable, will result in an increased blood
pressure
Determinants of blood pressure
 Blood pressure(BP)
• Arterial blood pressure is expressed in
four different terms;
i. Systolic blood pressure(SP)
ii. Diastolic blood pressure(DP)
iii. Pulse pressure
iv. Mean pressure
 Blood pressure(BP)
• Systolic blood pressure (SP) 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 (DP) the
minimum pressure exerted in the arteries
during diastole of heart
 Blood pressure(BP)
• Normal diastolic pressure: 80 mm Hg (60 mm
Hg to 80 mm Hg)
• Pulse pressure is the difference between the
systolic pressure and diastolic pressure.
• Normal pulse pressure: 40 mm Hg (120 – 80
= 40)
• Pulse can be felt as a pulsation or throb in
the arteries of the wrist or neck with each
heartbeat
 Blood pressure(BP)
• Mean arterial blood pressure is the average
pressure existing in the arteries
• It is the diastolic pressure plus one third of pulse
pressure
• To determine mean pressure, diastolic pressure
is considered than the systolic pressure
• It is because, the diastolic period of cardiac
cycle is longer (0.53 second) than the systolic
period (0.27 second)
 Blood pressure(BP)
• Formula to calculate mean arterial blood
pressure:
 Mean arterial blood pressure
= Diastolic pressure + 1/3 of pulse pressure
= 80 + (1/3 *40)mmHg
= 93.3mmHg
Mean pressures in systemic circulation
BLOOD VESSEL MEAN PRESSURE(mmHg)
AORTA 100
ARTERIOLES 50
CAPILARIES 20
VENA CAVA 4
 Physiological variations in blood
pressure
• Age (Increases as one ages)
• Sex(about 5mmHg less in females)
• Body built(↑in obese people)
• Diurnal variation(↓in morning and evening)
• After meals (↑ after meals due to ↑ CO)
• During sleep (↓ during sleep)
• Emotional conditions (↑Excitement, anxiety &
stress due to adrenaline release)
• Exercise (↑ Exercise)
Measurement of blood pressure(BP)
Measurement of blood pressure(BP)

• Blood pressure is measured by two methods:

A. Direct method
B. Indirect method
Direct method is used in animals only. It
involves cannulating the carotid artery and
connecting it to mercury manometer
Using a kymograph or by connecting cannula
to electronic pressure transducer, a
continuous record of pressure is obtained
Measurement of blood pressure(BP)

• Indirect method is used to measure arterial

blood pressure in man as well as in animals
• Apparatus:Sphygmomanometer, stethoscope
• Principle: When external pressure is applied
over the artery, blood flow through it is
obstructed
• The pressure required to cause occlusion of
blood flow indicates the pressure inside the
vessel
 Procedure of BP measurement
• The arm cuff of sphygmomanometer is
tied around upper arm, above the cubital fossa to
occlude the brachial artery
• Cuff should not be too tight or too loose
• Now, blood pressure can be measured by three
methods
i. Palpatory method
ii. Auscultatory method→ Most accurate and
commonly used method
iii. Oscillatory method
i. Palpatory method(Procedure)
• The radial pulse is felt first
• While feeling the pulse, pressure is increased in
the cuff by inflating air into it
• While doing this, mercury column in the
sphygmomanometer shows the pressure
in the cuff
• When cuff pressure is higher than systolic
pressure, brachial artery is compressed and blood
flow is obstructed and radial pulse disappears
i. Palpatory method(Procedure)
• When radial pulse disappears, the pressure is
further increased by about 20 mm Hg
• Pressure in the cuff is slowly reduced by
releasing the valve of the hand pump, i.e. the cuff is
deflated slowly
• This is done by feeling the pulse and simultaneously
watching the mercury column in the apparatus
• Pressure is noted when the pulse reappears and it
is recorded as systolic pressure
• This method does not measure diastolic pressure
 ii. Ascultatory method(procedure)
• An inflatable cuff containing a pressure
gauge is wrapped around the upper arm,
and a stethoscope is placed in a spot on the
arm just below the cuff where the brachial
artery lies.
• The cuff is then inflated with air until no
pulse is felt or no sound is heard
• Inflate an extra 20mmHg after
disappearance of the brachial pulse
 ii. Ascultatory method(procedure)
• The air in the cuff is then slowly released,
causing the pressure in the cuff and on the
artery to drop
• When cuff pressure has fallen to a value
just below the systolic pressure, the artery
opens slightly and allows blood flow for a
brief time at the peak of systole
• At this point a clear tapping sound(first
korotkoff sound) is heard
 ii. Ascultatory method(procedure)
• The cuff pressure at which the first korotkoff
sound is heard is identified as the systolic
pressure
• As cuff pressure is further lowered murmuring
sounds appear, then a clear gong sound and
lastly muffled sounds are heard
• When brachial artery is complentely open, muffled
sounds disappear
• The cuff pressure at which muffled sounds
disappear is identified as the diastolic pressure
 iii. Oscillatory method
• When pressure in the arm cuff is increased
above the level of systolic pressure, the
artery is occluded due to compression
• At this stage, the mercury column in the
manometer remains static
• When the pressure is gradually reduced,
some oscillations occur at the top of the
mercury column
 iii. Oscillatory method
• While deflating the cuff further, the amplitude
and duration of oscillations increase suddenly
• It denotes systolic pressure.
• When the cuff pressure is reduced further, the
amplitude and duration of oscillations is
reduced
• It reflects the diastolic pressure
• Because of its inaccuracy, this method is not
followed in routine clinical practice
 Regulation of blood pressure
• TWO MAJOR MECHANISMS
(I) NEURAL BARORECEPTOR
MECHANISMS
 Fast, short term regulation
(II) HUMORAL(HORMONARY REGULATED
RENIN-ANGIOTENSIN ALDOSTERONE)
MECHANISMS
 Slower, long term regulation
 Baroreceptor reflex
• Includes fast, neural mechanisms.
• Is a negative feedback system that is
responsible for the minute-to-minute
regulation of arterial blood pressure.
• These baroreceptors are stretch receptors
located in the aortic arch and in the carotid
sinus
 Baroreceptor reflex
• An increase in pressure causes the walls
of these arterial regions to stretch
stimulating the baroreceptors
• Baroreceptors send action potentials to
medulla oblongata via vagus and
glossopharyngeal nerves
• The medulla oblongata gives a response
though the autonomic nervous system
 Baroreceptor reflex
• A fall in pressure below the normal range, by contrast,
causes a decrease in the frequency of action
potentials produced by these sensory nerve fibers
• The vasomotor control centers in the medulla controls
vasoconstriction/vasodilation, and hence helps to
regulate total peripheral resistance.
• The cardiac control centers in the medulla regulates
the cardiac rate
• The baroreceptor reflex is activated whenever blood
pressure increases or decreases
 Baroreceptor reflex
• Increased baroreceptor discharge due to
higher than normal BP inhibits the tonic
discharge of sympathetic nerves and
excites the vagal innervation of the heart
• These neural changes produce
vasodilation, venodilation, a drop in blood
pressure, bradycardia, and a decrease in
cardiac output
 (ii)Renin-angiotensin aldosterone system

• Slow, hormonal mechanism

• A decrease in renal perfusion pressure causes
the juxtaglomerular cells of the afferent arteriole to
secrete renin.
• Renin is an enzyme that catalyzes the
conversion of angiotensinogen to angiotensin I in
plasma
• Angiotensin-converting enzyme (ACE) catalyzes
the conversion of angiotensin I to angiotensin II,
primarily in the lungs
(ii)Renin-angiotensin aldosterone system

• Angiotensin II has two effects:

(i) It stimulates synthesis and secretion of aldosterone
by the adrenal cortex.
• Aldosterone increases Na⁺ reabsorption by the renal
distal tubule, thereby increasing extracellular fluid
(ECF) volume, blood volume, and arterial pressure.
• This action of aldosterone is slow because it requires
new protein synthesis.
(ii) It causes vasoconstriction of the arterioles, thereby
increasing TPR and mean arterial pressure
END!