BLOOD PRESSURE

Physiological control

Nov 2012

Definition
BP is the pressure exerted by circulating blood upon the walls of blood vessels

BP vs Age
Approximate age Systolic Diastolic

1 to 12 months 1 to 4 years 3 to 5 years

75100 80110 80110

5070 5080 5080

6 to 13 years 13 to 18 years

85120 95140

5080 6090

Factors that influence BP

Rate of pumping (heart rate)
volume of blood from heart (cardiac output) = HR x stroke volume (the amount of blood pumped out from the heart with each contraction).

Resistance of blood vessels

resistance is produced mainly in the arterioles and is known as the systemic vascular resistance (SVR) or the peripheral vascular resistance (PVR).

BP = cardiac output x SVR

Factors (cont)
Viscosity, or thickness of the fluid
If the blood gets thicker, the result is an increase in arterial pressure. Certain medical conditions can change the viscosity of the blood e.g. anemia (low red blood cell concentration), reduces viscosity

Volume of fluid or blood volume

The more blood present in the body, the higher the rate of blood return to the heart and the resulting cardiac output. There is some relationship between dietary salt intake and increased blood volume, potentially resulting in higher arterial pressure.

Physiological mechanisms to maintain normal blood pressure

Autonomic nervous system responses Capillary shift mechanism Hormonal responses Kidney and fluid balance mechanisms

These different mechanisms are not necessarily independent of each other

Autonomic nervous system responses

ANS is the most rapidly responding regulator of BP It receives continuous information from the baroreceptors (pressure sensitive nerve endings) situated in the carotid sinus and the aortic arch. This information is relayed to the brainstem to the vasomotor centre (VMC). ANS adjusts the mean arterial pressure by altering both the force and speed of the heart's contractions, as well as the total peripheral resistance A decrease in BP causes activation of the sympathetic nervous system resulting in increased contractility of the heart (beta receptors) and vasoconstriction of both the arterial and venous side of the circulation (alpha receptors)

Parasympathetic HR Stroke volume vasodilatation

Sympathetic HR, stroke volume vasoconstriction

Carotid bodies A.k.a carotid glomus or glomus caroticum Are small clusters of chemoreceptors and supporting cells located near bifurcation of the carotid artery. The carotid body detects the following changes in the composition of arterial blood flowing through partial pressure of O2, but also of CO2. pH temperature. it responds to a stimulus, & triggers an action potential through the afferent fibers of the glossopharyngeal nerve, which relays the information to the CNS.

Capillary fluid shift mechanism

Is the exchange of fluid that occurs across the capillary membrane between the blood and the interstitial fluid. This fluid movement is controlled by capillary blood pressure interstitial fluid pressure, colloid osmotic pressure of plasma.

Hormonal mechanisms
These act in various ways including vasoconstriction, vasodilation and alteration of blood volume. The principal hormones raising blood pressure are:
a) Adrenaline and noradrenaline secreted from the adrenal medulla in response to sympathetic nervous system stimulation. They increase cardiac output and cause vasoconstriction and act very rapidly. b) Renin and angiotensin production is increased in the kidney when stimulated by hypotension Angiotensin is converted in the lung to Angiotensin II, which is a potent vasoconstrictor. In addition these hormones stimulate the production of aldosterone from the adrenal cortex which decreases urinary fluid and electrolyte loss from the body.

Kidney and fluid balance mechanisms

Kidneys help to regulate the blood pressure by: increasing or decreasing the blood volume By renin-angiotensin system (described previously).

They are the most important organs for the longterm control of blood pressure.

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CORONARY FLOW
Are coronary arteries end vessels? Are they physiological or anatomical anastomoses? What happens in the event of ischemia?

 The coronary arteries are classified as "end circulation", since they represent the only source of blood supply to the myocardium

coronary arteries do meet but these meetings are referred to as anatomical anastomoses because they lack function, as opposed to functional or physiological anastomoses like that in the palm of the hand. When two arteries or their branches join, the area of the myocardium receives dual blood supply.

 Blockage of one coronary artery results in death of the heart tissue due to lack of sufficient blood supply from the other branch. If one coronary artery is obstructed by an atheroma, the second artery is still able to supply oxygenated blood to the myocardium. However this can only occur if the atheroma progresses slowly, giving the anastomoses a chance to proliferate.