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Blood pressure :
It is the lateral pressure exerted by flowing
blood against any unit area of the vessel wall.

Cardiovascular system " Determinates of blood pressure:

BLOOD PRESSURE
Blood pressure

= cardiac output x total peripheral resistance

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Lateral pressure: Types: Four types

1.systolic blood pressure

It is pressure when force is exerted at right
angles to the direction of fluid(blood) flow at
any point within a tube(blood vessels). 2. Diastolic blood pressure

Biood Pressure
3. Pulse pressure

4. Mean pressure
Presure
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Systolic blood pressure: Diastolic pressure:

Maximum pressure during systole Minimum pressure during diastole.

Range: l00-13o mm of Hg Range : 60-90 mm of Hg
Average: 12o mm of Hg Average: 80 mm of Hg
" Importance: Systolic pressure indicates " Importance: Distolic pressure indicates
> The extent of work done byheart.
The force with which the heart is working. > The constant load against which the heart
works.
> It is the index of cardiac output.
> It is the index of peripheral resistance.

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 Mean pressure_:
Pulse pressure:

Difference between systolic and diastolic Average arterial pressure throughout the cardiac
pressure
cycle
Range : 85-100 mm of Hg.
Range : 40- 60 mm of Hg Calculation:
Mean pressure: Diastolic pressure + 1/3 of
Importance: It is related with stroke volume &
pulse pressure
vascular resistance.
" Why we calculate mean pressure?
- Duration of diastole more than duration of
systole

" Factors affecting blood pressure:

" Significance of mean pressure: Age: Blood pressure increases with age.
In old age, it increases due to
Blood flows through the blood vessel is due to mean
Atherosclerotic change in the artery
and walls become thick, elasticíty decreases.
pressure
As a result tissue perfusion occur. Sex: more in male than female.

Body built: Systolicblood pressure is usually

high in obese person.

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Exercise:

" In mild, moderate, severe exercise " Respiration: During inspiraton blood pressure
systolic pressure is increased decrease & expiration blood pressure
increase.
" In mild to moderate exercise
" Emotion, excitement, after meal: Increased
diastolicpressure remains unchanged systolic pressure,
In severe exercise, diastolic pressure decreased.
Posture: During standing,systolic pressure
decreased but diastolic pressure increased.

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 Factors controlling/ regulating blood Regulation of blood pressure:
pressure:
" Short term regulation: occurs within
Cardiac output. seconds.
Peripheral resistance. a)Baroreceptor feedback mechanism.
Measurement of blood pressure: b)Chemoreceptor feedback mechanism.
1.Direct method.
2. Indirect method: c) Centralnervous system ischemic
mechanism
Palpatory method- can measure only systolic
pressure
Auscultatory method- can measure both systolic and
diastolic pressure.
Oscillatory method
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Baroreceptor feed back mechanism:

" Intermediate term regulation: occurs within
minutes.
" Baroreceptors/ pressoreceptors:
a) Renin angiotensin vasoconstrictor mechanism " stretch spray type nerve endings (receptor)
b) Capillary fluid shift mechanism. in the wallof the arteries.
c) Stress relaxation in vasculature. "Stimulated when stretched.
" Long term regulation: occurs within hours, Location of baroreceptors:
days or even weeks. 1. Extremely abundant in
a) Renal body fluid mechanism.
i) the wallof the each internal carotid
artery slightly above the carotidbifurcation,
b) Renin angiotensin aldosterone mechanism. known as the carotid sinus.
ii) The wall of the aortic arch.

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2. Afew baroreceptors are located in the wall Baroreceptor system for controlling blood
pressure:
of large artery of the thoracic and neck
region.
Response to baroreceptors to pressure: ksyngealreve

1)Carotid sinus receptors: They are stimulated

when pressure above 50-60 mmHg and reach Carad Lyoty
aroud s
amaximum at about 180mmHg. Vaqus nene

2)Aortic baroreceptors: The response of these

are similar to those of carotid receptors except -Aortic baroteceptom

they are stimulated when pressure above

30mmHg.
The tyarCR ONgtN ysteYY tx c t r o k r Ntrii e e A

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 "Conversely, low pressure has opposite effects, 2. Postural change :
reflexly causing the pressure to rise back toward
normal Immediately on standing after lying down,
the head and
" Importance of baroreceptor reflex the arterial blood pressure in
tends to fall.
mechanism: upper parts of the body
immediate reflex,
1. Buffer regulating mechanism: " Baroreceptors elicits an
Nerves of baroreceptors are called buffer resulting in strong sympathetic discharge
nerve. throughout the body.
Baroreceptors system opposes an increased " This minimizesthe decrease in pressure in
and a decreased in arterial pressure, so it is the head and upper body.
called pressure buffer system. " 3. Diurnal variation.

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Chemoreceptor feedback mechanism: Chemoreceptor feedback mechanism contd.

" Chemoreceptors: Chemosensitive cells " Each carotid and aortic body is supplied with
sensitive to oxygen lack, carbondioxide excess an abundent blood flow through nutrient
and hydrogen ion excess. artery,so that the chemoreceptors are always
Chemoreceptors are in close contact with arterial blood.
Carotid bodies: Two in numbers, lies in When the arterial pressure falls below
the bifurcation of each common carotid 80mmHg, chemoreceptorsstimulated. They
artery. send impulse to vasomotor center and arterial
Aortic bodies: one to three in numbers, pressure increased back towards normal.
lies adjacent to aorta.

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Mechanism :
Vasomotor center of brainstem
Arterial pressure (below 80 mm Hg )
(+) Vasomotor center
blood supply to chemoreceptor

Hypoxia (Vo,), excess co, excess Ht Vasoconstriction ‘ Force ofcontraction

Chemoreceptors stimulated
‘ Arterial blood pressure
Signals pass through Hering's nerve and Vagas
nerve

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 Central nervous system ischemic response:
The control of arterial pressure by the brain " It is anemergency pressure control system,
vasomotor center in response to cerebral that prevent the further decrease of blood
ischaemia is called CNS ischaemic response pressure to lethal level.
" When the arterial pressure falls below This pressure control system is also known as
60mmHg to as low as 15 to 20 mmHg,this last ditch stand' pressure control mechanism
response increased the arterial pressure
towards normal.

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Central nervous system ischemic response:

L Blod flow to vasomotor center in Vasoconstriction
the lower brain stem

^Arterial presSure
Cerebral ischemia

‘ cerebral blood flow

Accumulation of C0,, lactic acid and
metabolites in the vasomotor center

(+) Vasomotor center

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Intermediate term regulation:

" Renin-angiotensin vasoconstrictor mechanism:

Renin is an enzyme, coming from JG
(Juxtraglomerular) cell of kidney during hypoxia
(Decreased arterial pressure).
Argksens
Renin acts on plasma protein angiotensinogen to Angtotarrsinas
form angiotensin L.
Vaoontyoion

Angiotensin I is then converted to angiotensin |in

the endothelium of lung vessels by the action of ACE
(angiotensin converting enzyme).
Angiotensin I| is a powerful vasoconstrictor, causes Renin angiotensin vasoconstriction
increased peripheral resistance mechanism
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 Stress relaxation mechanism:
" Capillary Fluid shift mechanism:
pressure in the blood vessels
low’ fluid " When the become stretched for
" If the capillary pressure falls to becomes too high, they
absorbed through capillary membrane from minutes or hours.
tissues into circulation ’ blood volume vessels falls
in the
increased ’ Increased capillary pressure. As aresult, the pressure
towards normal.
When capillary pressure rises ’ fluid lost the vessels called
from circulation into tissues ’ blood volume This continuing stretch of
stress relaxation.
decreased’ decreased the capillary pressure.

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Renin angiotensin vasocostrictor

mechanism :

L Blood pressure

Blood flow to Juxtraglomerular complex

Renal Ischemia

Renin

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Angiotensin -l

Angiotensinogen Vasoconstrictor Renal tubules

Angiotensin -
‘Total peripheral Na", Cl and H,0 reabsorption
ACE (Lung)
Angiotensin -l|
resistance ‘ Blood volume

^ Blood pressure ‘ VR

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 oLong term regulation ‘ Blood pressure
1. Renal body fluid mechanism:
‘ Extracellular fluid volume ‘ GFR (Glomerular filtration rate)

Blood volume Pressure diuresis and pressure natriuresis

‘ Venous return L Blood volume

cO

7 Cardiac output L venous return

L BP

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Renin angiotensin aldosterone

mechanism: Angiotensinogen
L Blood pressure
Angiotensin -
J Blood flow to Juxtraglomerular complex ACE (Lung)
Angiotensin -Il
Renal Ischemia

Renin

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Angiotensin | Hypertension:
Vasocomstrictor Renal tubules (+}'Adrenal "Definition: Hypertension is a clinical
cortex condition characterized by
‘Total peripheral Na, Cl and H,0 reabsorption
persistence rise of blood pressure
Secreion of
above the normal range in respect of
aldosterone age and sex.
resistance ‘ Blood volume Hypertension occurs when diastolic
blood pressure is greater than
‘ Blood pressure ‘ VR 90mmHg and systolic pressure is
above 150mmHg.
‘ CO

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 Hypertension contd.
" Hypertension is two types:
1. Primary or essential hypertension.
2. Secondary hypertension.
D Primaryor essential hypertension: The exact cause
of this hypertension is unknown. May be due to
familial cause.
Secondary hypertension: This hypertension is due
toother diseases, such as
1. Renal artery stenosis. 2. Thyroid disorder
(Hypothyroidism)
3. Coarctation of aorta etc.

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