Alterations in Blood Systemic arterial

Pressure blood pressure

is the
 Arterial Blood
physiologic
Pressure
result of the
produced by the
cardiac output
force of the left
and the
ventricular
resistance to the
contraction
ejection of blood
overcoming the
from the heart.
resistance of
Cardiac output
aorta to open
(CO) is the
aortic valve.
product of 2
the pressure
variables: stroke
maintained in
volume (SV) and
arterial system
heart rate (HR)
throughout the
(CO = SV × HR).
cardiac cycle.
Stroke Volume
 Determinants of
is the specific
Systemic Blood
volume of blood
Pressure
leaving the heart
 with each  Measurement of
contraction. Blood Pressure
Preload is Systolic blood
determined by pressure is the
the amount of peak pressure in
blood returned the aorta during
to the heart ventricular
between contraction.
contractions. Diastolic blood
Systemic pressure is the
vascular minimum
resistance (SVR) pressure during
is the resistance ventricular
to ejection into diastole.
the arterial  Pulse Pressure is
circulation. the difference
Major between systolic
determinant and diastolic
of diastolic BP blood pressure.
Mean Arterial
Pressure (MAP)
is the calculated
 average pressure (proteinuria) is
within circulatory reflective of
system increased
throughout the glomerular
cardiac cycle. permeability
Korotkoff sounds and an early
is the sounds indicator of
produced by the hypertensive renal
turbulent flow injury.
through the  Primary
partially Hypertension
occluded artery. also called
 Metabolic essential
Syndrome hypertension,
Characterized by does not have a
elevated clearly identifiable
circulating insulin known etiology
and lipid levels, and is therefore
hypertension, and an idiopathic
obesity. disorder.
 The presence of  Secondary
microalbuminuria Hypertension
 When o Family History
hypertension is o Obesity
found to have a o Sedentary
specific Lifestyle
identifiable cause. o Metabolic
the elevated Syndrome
blood pressure is o Diet
the result of o Tobacco Use
identifiable  Labs
pathologic o ↑ CBG
conditions or o ↑ Total
certain drugs or Cholesterol
foods. o ↑ Triglycerides
It is less common
o ↑ LDL
in adults, but is
o ↓ HDL
the major cause
 Lifestyle
of hypertension in
Modifications to
children.
Treat and Prevent
 Risk Factors for
Primary
Developing Primary
Hypertension
Hypertension
o Increasing age
 o Weight hemorrhagic
Reduction stroke, liver
o DASH diet failure, and acute
o Low Sodium renal failure are
Intake all potential
o Exercise outcomes of
o Moderate hypertension
Intake of during pregnancy.
alcohol When HTN is
diagnosed during
pregnancy, it is
 Hypertension classified into
during Pregnancy one of 4
Hypertension categories:
arises in 5-12% of chronic
all pregnancies. hypertension
Preterm labor, (preexisting),
abruptio preeclampsia,
placentae, chronic
disseminated hypertension
intravascular with
coagulation, superimposed
 preeclampsia, or a long-term
or gestational basis.
hypertension.  Hypertensive crisis
 Obstructive sleep (HTN-C) was the
apnea (OSA) is term
closely associated introduced to
with obesity; it is replace the initial
found in 2-4% of term malignant
adults, and hypertension.
hypertension is Hypertensive
present in 45-60% emergencies
of those diagnosed are situations
with OSA. characterized
 Pheochromocytom by a sudden
a is a increase in
catecholamine- either or both
secreting tumor of systolic and
the adrenal medulla diastolic
that generates pressures
hypertension on accompanied
either a short-term by evidence of
 acute end- that is ≥10 mm Hg
organ damage. within 3 minutes
Hypertensive of moving to an
urgency upright position.
describe similar  Short Term
blood Regulation of
pressure Systemic Blood
elevations, but Pressure
without the is mediated by the
end-organ sympathetic
damage. branch of the
 Orthostatic autonomic
Hypotension is the nervous system
drop in blood (the sympathetic
pressure with nervous system
position change. [SNS]).
a decrease in Activation of the
systolic blood SNS influences
pressure of ≥20 both heart rate
mm Hg or a and SVR.
decrease in The autonomic
diastolic pressure nervous system
 maintains a basal during periods of
level of arteriolar rest.
smooth muscle  Long Term
tone through the Regulation of
SNS and provides Systemic Blood
heart rate control Pressure
through a balance the role of the
of SNS and renin–
parasympathetic angiotensin–
nervous system aldosterone
(PSNS) activity. system (RAAS) has
Stimulation of the been seen as the
SNS results in the primary
increased release contributor to this
of the process.
neurotransmitters Prorenin, the
epinephrine and inactive form of
norepinephrine. renin, is
PSNS is synthesized and
responsible for stored by
maintaining a specialized smooth
slower heart rate muscle cells
 located in the resulting in the
afferent arterioles release of
of the kidney. angiotensin I, a
Juxtaglomerular peptide possessing
cells are stimulated minimal
by a decrease in vasoconstrictive
arterial pressure to capacity.
enzymatically Angiotensin I
cleave the continue to be
precursor and created by renin
release the for about 30-60
activated renin mins, until renin is
enzyme into the removed from the
vascular bed of the body. While the
kidney. blood carrying
Most of the renin angiotensin I
travels into the circulates through
general circulation, the pulmonary
where it acts on a vessels, an enzyme
circulating plasma produced by the
protein called vascular
angiotensinogen, endothelium
 (angiotensin- increased, raising
converting enzyme BP.
[ACE]) comes in Angiotensin II also
contact with is an intermediary
angiotensin I, and 2 for an additional
amino acids are means of raising
fragmented from blood pressure—
angiotensin I to increasing
produce circulating volume
angiotensin II. to significantly
 Angiotensin II increase venous
Angiotensin II is an return to the heart
extremely potent and therefore
vasoconstrictor, stroke volume.
primarily of the In the general
arterial bed, but circulation reaches
also slightly the cortex of the
affecting the adrenal glands,
venous system. stimulating the
The SVR is release of the
therefore hormone
aldosterone.
Aldosterone movement, and
circulates to the release of renin.
kidneys, where it  Suprachiasmatic
binds to receptors nuclei—the body’s
in the renal internal clock.
tubules, causing  For those
the kidneys to individuals age 18
reabsorb more years and older,
sodium. normal blood
Endothelin-1 (ET- pressure is defined
1) is a peptide as <120 mm Hg
produced in the systolic and <80
renal medulla. It mm Hg diastolic;
binds to receptors stage 1
within the kidney, hypertension
initiating an begins at a systolic
autocrine-induced pressure of 140 mm
vasodilatory Hg or a diastolic
response affecting pressure of 90 mm
renal perfusion, Hg.
water & electrolyte