ARTERIAL
BLOOD
PRESSURE
Dr. Mahreen Siddique
ARTERIAL BLOOD PRESSURE
The force exerted by the blood against any unit area of the vessel wall.
Arterial blood pressure is defined as
“The lateral pressure exerted by the column of blood on wall of arteries. The
pressure is exerted when blood flows through the arteries. Generally, the
term ‘blood pressure’ refers to arterial blood pressure.”
Arterial blood pressure is expressed in following terms:
1. Systolic blood pressure
2. Diastolic blood pressure
SYSTOLIC BLOOD PRESSURE
Systolic blood pressure (systolic pressure) 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
Diastolic blood pressure (diastolic pressure) is defined as the minimum
pressure exerted in the arteries during diastole of heart.
Normal diastolic pressure: 80 mm Hg (60 mm Hg to 80 mm Hg).
FACTORS MAINTAINING
ARTERIAL BLOOD PRESSURE
Some factors are necessary to maintain normal blood pressure.
These factors are called local factors, mechanical factors or determinants
of blood pressure.
Types of Local Factors Local factors are divided into two types:
A. Central factors, which are pertaining to the heart:
1. Cardiac output
2. Heart rate
B. Peripheral factors, which are pertaining to blood and blood
vessels:
3. Peripheral resistance
4. Blood volume
5. Venous return
6. Elasticity of blood vessels
7. Velocity of blood flow
8. Diameter of blood vessels
9. Viscosity of blood.
A.CENTRAL FACTORS
1. Cardiac Output
Systolic pressure is directly proportional to cardiac output.
2. Heart Rate
Moderate changes in heart rate do not affect arterial blood pressure much.
However, marked alteration in the heart rate affects the blood pressure by
altering cardiac output (increases).
B.PERIPHERAL FACTORS
3. Peripheral Resistance
Peripheral resistance is the important factor, which maintains diastolic
pressure. Diastolic pressure is directly proportional to peripheral resistance.
Peripheral resistance is the resistance offered to the blood flow at the
periphery. Resistance is offered at arterioles, which are called the resistant
vessels. When peripheral resistance increases, diastolic pressure is
increased and when peripheral resistance decreases, the diastolic pressure
is decreased.
4. Blood Volume
Blood pressure is directly proportional to blood volume. Blood volume
maintains the blood pressure through the venous return and cardiac output.
If the blood volume increases, there is an increase in venous return and
cardiac output, resulting in elevation of blood pressure.
5. Venous Return
Blood pressure is directly proportional to venous return. When venous return
increases, there is an increase in ventricular filling and cardiac output,
resulting in elevation of arterial blood pressure.
6. Elasticity of Blood
Vessels Blood pressure is inversely proportional to the elasticity of blood
vessels. Due to elastic property, the blood vessels are distensible and are
able to maintain the pressure. When the elastic property is lost, the blood
vessels become rigid (arteriosclerosis) and pressure increases as in old age.
Deposition of cholesterol, fatty acids and calcium ions produce rigidity of
blood vessels and atherosclerosis, leading to increased blood pressure.
7. Velocity of Blood Flow
Pressure in a blood vessel is directly proportional to the velocity of blood
flow. If the velocity of blood flow increases, the resistance is increased. So,
the pressure is increased.
8. Diameter of Blood Vessels
Arterial blood pressure is inversely proportional to the diameter of blood
vessel. If the diameter decreases, the peripheral resistance increases,
leading to increase in the pressure.
9. Viscosity of Blood
Arterial blood pressure is directly proportional to the viscosity of blood. When
viscosity of blood increases, the frictional resistance is increased and this
increases the pressure.
REGULATION OF ARTERIAL
BLOOD PRESSURE
A. Nervous mechanism or short term regulatory
mechanism
B. Renal mechanism or long term regulatory mechanism
C. Hormonal mechanism
D. Local mechanism
1-NERVOUS MECHANISM FOR REGULATION OF BLOOD PRESSURE –
SHORT-TERM REGULATION
Nervous regulation is rapid among all the mechanisms involved in the
regulation of arterial blood pressure.
When the pressure is altered, nervous system brings the pressure back to
normal within few minutes. Although nervous mechanism is quick in action,
it operates only for a short period and then it adapts to the new pressure.
Hence, it is called short term regulation.
The nervous mechanism regulating the arterial blood pressure operates
through the vasomotor system.
VASOMOTOR SYSTEM
Vasomotor system includes three components:
1. Vasomotor center
2. Vasoconstrictor fibers
3. Vasodilator fibers.
1-VASOMOTOR CENTER
Vasomotor center is bilaterally situated in the reticular formation of medulla
oblongata and the lower part of the pons.
Vasomotor center consists of three areas:
i. Vasoconstrictor area
ii. Vasodilator area
iii. Sensory area.
i. Vasoconstrictor Area
Vasoconstrictor area is also called the pressor area. Vasoconstrictor area
sends impulses to blood vessels through sympathetic vasoconstrictor
fibers. So, the stimulation of this area causes vasoconstriction and rise in
arterial blood pressure.
ii. Vasodilator Area
Vasodilator area is otherwise called depressor area. This area suppresses
the vasoconstrictor area and causes vasodilatation.
iii. Sensory Area
This area receives sensory impulses via glossopharyngeal and vagal
nerves from the periphery, particularly from the baroreceptors. Sensory
area in turn, controls the vasoconstrictor and vasodilator areas.
2-VASOCONSTRICTOR FIBERS
Vasoconstrictor fibers belong to the sympathetic division of autonomic nervous
system. These fibers cause vasoconstriction by the release of neurotransmitter
substance, noradrenaline. Noradrenaline acts through alpha receptors of smooth
muscle fibers in blood vessels. Vasoconstrictor fibers play major role than the
vasodilator fibers in the regulation of blood pressure.
Vasomotor Tone
Vasomotor tone is the continuous discharge of impulses from
vasoconstrictor center through the vasoconstrictor fibers.
Vasomotor tone plays an important role in regulating the pressure by
producing a constant partial state of constriction of the blood vessels.
3-VASODILATOR FIBERS
Vasodilator fibers are of three types:
i. Parasympathetic vasodilator fibers
ii. Sympathetic vasodilator fibers
iii. Antidromic vasodilator fibers
i. Parasympathetic Vasodilator Fibers
Parasympathetic vasodilator fibers cause dilatation of blood vessels by releasing
acetylcholine.
ii. Sympathetic Vasodilator Fibers
Some of the sympathetic fibers cause vasodilatation in certain areas, by
secreting acetylcholine. Such fibers are called sympathetic vasodilator or
sympathetic cholinergic fibers. Sympathetic cholinergic fibers, which
supply the blood vessels of skeletal muscles, are important in increasing
the blood flow to muscles by vasodilatation, during conditions like exercise
iii. Antidromic Vasodilator
Fibers Normally, the impulses produced by a cutaneous receptor (like pain
receptor) pass through sensory nerve fibers. But, some of these impulses
pass through the other branches of the axon in the opposite direction and
reach the blood vessels supplied by these branches. These impulses now
dilate the blood vessels. It is called the antidromic or axon reflex.
MECHANISM OF ACTION OF VASOMOTOR
CENTER IN THE REGULATION OF BLOOD
PRESSURE
Vasomotor center regulates the arterial blood pressure by causing
vasoconstriction or vasodilatation.
However, its actions depend upon the impulses it receives from other
structures such as baroreceptors, chemoreceptors, higher centers and
respiratory centers.
Among these structures, baroreceptors and chemoreceptors play a major
role in the shortterm regulation of blood pressure.
1. Baroreceptor Mechanism
Baroreceptors are the receptors, which give response to change in blood
pressure. Baroreceptors are also called pressoreceptors.
Baroreceptors are situated in the carotid sinus and wall of the aorta.
2. Chemoreceptor Mechanism
Chemoreceptors are the receptors giving response to change in chemical
constituents of blood. Peripheral chemoreceptors influence the vasomotor
center.
Peripheral chemoreceptors are situated in the carotid body and aortic body
Mechanism of action of baroreceptors and chemoreceptors in carotid and
aortic region constitute sinoaortic mechanism. Nerves supplying the
baroreceptors and chemoreceptors are called buffer nerves because
these nerves regulate the heart rate, blood pressure and
respiration
RENAL MECHANISM FOR REGULATION OF
BLOOD PRESSURE – LONG-TERM
REGULATION
HORMONAL MECHANISM FOR
REGULATION OF BLOOD PRESSURE
LOCAL MECHANISM FOR REGULATION
OF BLOOD PRESSURE
1-LOCAL VASOCONSTRICTORS
Local vasoconstrictor substances are derived from vascular endothelium.
These substances are called endothelium-derived constricting factors
(EDCF). Common EDCF are endothelins (ET), which are peptides with 21
amino acids. Three types of endothelins ET1, ET2 and ET3 are identified so
far.
Endothelins are produced by stretching of blood vessels. These peptides act
by activating phospholipase, which in turn activates prostacyclin and
thromboxane A2 . These two substances cause constriction of blood vessels
and increase the blood pressure
2-LOCAL VASODILATORS
Local vasodilators are of two types:
i. Vasodilators of metabolic origin
ii. Vasodilators of endothelial origin.
i-Vasodilators of Metabolic Origin
Vasodilators of metabolic origin are carbon dioxide, lactate, hydrogen ions
and adenosine.
ii-Vasodilators of Endothelial Origin
Nitric oxide (NO) is an endotheliumderived relaxing factor (EDRF). It is
synthesized from arginine. Nitric oxide synthesis is stimulated by
acetylcholine, bradykinin, VIP, substance P and platelet breakdown products.
As nitric oxide is a vasodilator, deficiency of this leads to constant
vasoconstriction and hypertension.
