Regulation of Blood Pressure

Asst. Prof./ Manal M. Kamal

Physiology Department
At the end of this lecture, the student should be able
to:
- Outline the physiological basis of the mechanisms of regulation
of blood pressure.
- Describe the role played by renin-angiotensin system in
controlling blood pressure
-References:
- Textbook of Medical Physiology, By Guyton & Hill; W B Saunders Co 2016
(Chapter 18,19).
- Review of Medical Physiology, By Williams Ganong; Lange Medical Books
 Blood flow
Blood flow through a blood vessel is determined by
two factors:
Ohm’s law:
F = ΔP/R
(1) Pressure difference between the two ends ΔP
(2) Vascular resistance (R)
Blood pressure:
Def: The force exerted by blood against any unit area
of vessel wall.
• Measured in millimeters of mercury (mm Hg)
• Occasionally, measured in cm H2O (mm Hg =1.36 cm
H2O )
Importance: to maintain pressure for blood flow to
blood vessels and thus for tissues perfusion.
Types of blood pressure
 Systemic arterial blood pressure

• Components:
Systolic Blood Pressure SBP is
determined by
the cardiac
output

Diastolic Blood Pressure DBP is

determined by
the peripheral
resistance
 Factors determine (maintain) of blood pressure
Mean Arterial Blood Pressure (MABP)= COP X PR

1-Cardiac output (C.O.P):

A.B.P. is directly proportionate to the C.O.P {C.O.= S.V.
xH.R.}
• Stroke volume (S.V.) affects mainly systolic B.P.
• Heart rate (H.R.) affects mainly diastolic B.P.
2. Peripheral resistance (PR):
R α Lη/r4
Main site is small arterioles. Influenced by: length (L),
radius (r) of blood vs., viscosity of blood (η). In a normal
human, length fixed, so blood viscosity and radius of
blood vessels have the largest effects on resistance.
Radius:
– Vasodilatation → ↓peripheral resistance
– Vasoconstriction → ↑peripheral resistance
Blood viscosity:
mainly determined by RBCs count, less by plasma protein
3-Elasticity of the blood vessels.
• It is essential for production and maintenance of a
relatively high diastolic B.P.

4-Blood Volume and Circulatory Capacity:

• They determine A.B.P. by controlling the mean
systemic filling pressure which
• Increased by:-
↑blood volume or ↓ circulatory capacity.
• Decreased by:-
↓ blood volume or ↑circulatory capacity.
 Physiological variation of ABP
1. Age: In newly-born infants the blood pressure is 80/40.
Then it ↑ gradually till adult values, ↑ by age of 60 due
to decrease elasticity of arteries.
2. Sex: In adult male is higher than in adult female, but after
the menopause it becomes higher in females may be due
to hormonal changes (↓ estrogen) during this period.
3. Body built: usually higher in obese persons
4. Sleep: quiet sleep the ABP ↓ due to parasympathetic
5. Emotions: ABP ↑ due to sympathetic overactivity.
6. Meals: After meals the ABP ↑ due to:-
(a) The contraction of smooth muscles of the gut
compress the blood vessels thus increasing VR and COP.
(b) The vasodilatation occurs in the splanchnic area
increases the VR and also COP.
7. Gravity: During standing, blood pressure ↑in all vessels
below the heart and ↓ in vessels above.
8. Exercise: Increase systolic blood pressure.
9. Respiration: ↑ during late part of inspiration, early part
of expiration, ↓during remainder of the respiratory
cycle“respiratory pressure waves"
10. Diurnal : lowest in early morning.
 Regulation (Control) of A.B.P.

A. Short-term regulation
Become active within seconds.
Regulate: vessel diameter, heart rate and contractility.
It is mediated by nervous and chemical mechanisms.
Vasomotor center (VMC). :
In CNS control of blood Pressure is exerted by groups of
neurons in Medulla, called as Vasomotor area
Impulse from this area (both by sympathetic and vagal
system) regulate the heart rate, stroke volume and the
diameter of the arterioles.
Include:
Higher Control of ABP

19
1-Arterial baroreflexes:
by stimulation of baroreceptors
(in carotid sinus, aortic arch)
When A.B.P. increases.
a- Increase the A.B.P. →
Stimulate baroreceptors →
↓ H.R.,V.D.,&
↓ catecholamine secretion
(from adrenal medullae)
→ ↓ A.B.P.
b- The opposite
occurs when A.B.P. is
decreased.
2- Arterial chemoreflexes stimulation
a-↓A.B.P. → stimulates chemoreceptors (in carotid
and aortic bodies), as a result of (hypoxia) → ↑ HR.,
V.C., & ↑ catecholamine secretion (from adrenal
medullae) →↓ A.B.P.
b- The opposite occurs when A.B.P. is increased.

3)The abdominal compression reflex:

↑ A.B.P. → stimulates VCC → stimulates medullary
reticular formation → send signals that increase
skeletal muscle tone ( abdominal muscle)→ ↑ A.B.P.
(by compressing abdominal veins ↑ venous return).
4) CNS-ischemic response:
ABP below 60 mmHg causes brain ischemia resulting
in local hypoxia which stimulates the VCC
resulting in generalized V.C. which elevates the
A.B.P. and maintain cerebral blood flow.
N.B. :
• The same effect occurs in cases of ↑intracranial
pressure (Cushing's reflex= (hypertension ,
bradycardia, irregular respirations).
 B-Intermediate-term mechanisms

Act after many minutes:

1-Capillary fluid shift mechanism:
↑blood volume→ ↑ capillary hydrostatic pressure→
fluid filtration, and ↓ blood volume, so A.B.P. is ↓

2-Stress relaxation mechanism:

• ↑ A.B.P. stretches the arteries ↑ tension in their walls.
• After sometimes the arteries relax (Stress relaxation)
helping decrease A.B.P.
3-Renin-angiotensin V.C. mechanism:
↓A.B.P. →renal ischemia → stimulates secretion of renin
from kidneys act on angiotensinogen (α2 globulin) →
angiotensin I which is converted into angiotensin II by
angiotensin converting enzyme (ACE) {in the lungs}.
Angiotensin II has a potent V.C. effect →↑A.B.P.

4-Right atrial mechanism:

↑blood volume stimulates volume receptors in right
atrium ( type B receptors) causing:
1-Generalized V.D. 2- Reflex inhibition of A.D.H.
secretion
3- Secretion of ANP (salt and water excretion by kidneys)
. These effects help lowering A.B.P.
 C-Long -term mechanisms

• Active within days.

• Control A.B.P. by modifying the excretion of water
and salt by the kidneys.
• Through:-
• 1-Glomerular filtration.
• 2-Aldosterone hormone secretion.
A-Decrease A.B.P.:- .
1- ↓ glomerular filtration & urine flow →excretion of
water and salt by the kidneys ↓
2-Renin is secreted and angiotensin II is formed.
Angiotensin II effects:
1-Generalized V.C.
2- Stimulates aldosterone horm. secretion from adrenal
cortex →↑sodium & water reabsorption in kidney DCT
3- Stimulation of hypothalamus osmoreceptors →Release
of ADH →↑water reabsorption by the kidneys.
4. Increases thirst sensation
• All these effects increase body fluids and blood volume,
raises the A.B.P. to the normal level.
B-Increase A.B.P.:-
.
1) ↑ glomerular filtration & urine flow (so, the
excretion of water and salt by the kidneys is ↑
{called pressure diuresis}.
2) At the same time, renin secretion is inhibited and
angiotensin II , aldosterone is not formed.

All these effects decrease body fluids and blood

volume, reduces the A.B.P. to the normal level.