Adv Physiol Educ 40: 477–479, 2016;
doi:10.1152/advan.00074.2016.
Conceptualizing physiology of arterial blood pressure regulation through
the logic model
Lalitbhushan S. Waghmare1 and Tripti K. Srivastava2
1
Inter-disciplinary Health Sciences, Department of Physiology, Datta Meghe Institute of Medical Sciences (Deemed
University) Sawangi (M), Wardha, Maharashtra, India; and 2Department of Physiology, Datta Meghe Institute of Medical
Sciences (Deemed University) Sawangi (M), Wardha, Maharashtra, India
Submitted 5 May 2016; accepted in final form 31 August 2016
The Concept
THE LOGIC MODEL (also known as a logical framework, theory of
change, or program matrix) is a tool used by funders, manag-
ers, and evaluators of a program to evaluate its effectiveness. It
is a graphical depiction of logical relationships between the
resources, activities, outputs, and outcomes of a program (3, 7,
11, 12). Although there are many ways in which logic models
can be presented, the underlying purpose of constructing a
logic model is to assess the “if-then” (causal) relationship
between the elements of a program. If resources are available
for a program, then the activities can be implemented; if the
activities are implemented successfully, then certain outputs
and outcomes can be expected. A logic model thus has four
major components: inputs, activities, outputs, and outcomes (3,
8, 9, 11, 12) (Table 1).
Physiology deals with normal functioning of the human
body wherein various regulatory mechanisms work together to
establish homeostatic environment. The understanding of ho-
meostasis has evolved since its original formulation; however,
the core concept captured by Cannon’s phrase “Wisdom of the
Body” remains its defining property (1). Wisdom of the body
describes how an array of physiological and behavioral re-
sponses are elicited in a seemingly coordinated way to stabilize
or defend critical physiological parameters. Blood pressure and
blood sugar are the vital physiological variables, as defined by
Walter Cannon in 1929, wherein homeostasis is the principle
underlying physiological regulation for ongoing maintenance
and defense. A fundamental tenet of homeostatic regulation is
that variables work together in a coordinated fashion to wisely
defend bodily parameters critical to well being (2). They are
programmed in such a way that, if one input falters, there are
multiple alternative mechanisms to regulate. The body is ac-
customed to such mechanisms, which in technological terms
can be considered as a program. The array of inputs through
their respective mechanisms work in unison to achieve a
defined product (i.e., output and outcome).
This principle of regulated outcome, as explained through
the logic model, can help in understanding physiological prin-
ciples to maintain homeostasis. We explored this model by
fitting in the inputs, processes, outputs, and outcomes for
teaching arterial blood pressure (ABP) regulation to undergrad-
uate students of first phase in medicine.
Address for reprint requests and other correspondence: L. S. Waghmare,
Inter-disciplinary Health Sciences, Dept. of Physiology, Datta Meghe Institute
of Medical Sciences (Deemed University), Sawangi (M), Wardha, Maharash-
tra, India 442001 (e-mail: drlalitwaghmare@gmail.com).
1043-4046/16 Copyright © 2016 The American Physiological Society
Downloaded from journals.physiology.org/journal/advances (202.043.093.018) on April 3, 2023.
Illuminations
Description
This idea was developed to design a logic model of ABP
regulation (Table 2) for undergraduate students of first phase in
subject of Physiology, Jawaharlal Nehru Medical College,
Datta Meghe Institute of Medical Sciences (Deemed Univer-
sity). The description in brief is as follows (6).
Input. Blood pressure is the pressure exerted by blood on
walls of the arteries. Various inputs that are instrumental in
physiological regulation of blood pressure can be grouped into
the following:
A. General factors: general factors are physiological factors
that determine the range of blood pressure, viz., age, sex,
hereditary, meals, sleep, emotions, gravity, and diurnal
variations.
B. Circulatory factors: the major circulatory factor that can
cause alteration is mainly cardiac output, which depends on
stroke volume and peripheral resistance. Stroke volume is
the amount of blood ejected by each ventricle per beat. It is
dependent mainly on myocardial contractility and end-dia-
stolic volume. Peripheral resistance is the resistance offered
by the arterial system to the outflow of blood. Factors that
determine peripheral resistance are 1) arteriolar radius,
which depends on intrinsic, i.e., myogenic and metabolic
factors and extrinsic, i.e., hormonal, paracrine, and neuro-
genic factors; 2) length of the vessel; 3) and viscosity of
blood. This flow-pressure-resistance relationship can be ex-
plained by Poiseuille-Hagen law (4, 5, 10, 13, 14). Other
important factors are elasticity of vessel wall and velocity of
blood flow.
Process. All of these inputs lead to four major physiological
processes taking place in the body to keep blood pressure varia-
tions within normal limits. The activities occur either simultane-
ously or one after the other. The activities can be grouped into the
following: 1) nervous regulation (sympathetic and parasympa-
thetic systems), 2) intrinsic physical regulatory mechanisms,
3) autoregulatory mechanisms, and 4) hormonal mechanisms.
Output. The various processes as mentioned above have dif-
ferent areas of operation. They can be grouped into short, inter-
mediate, and long-term mechanisms. The output through short-
term mechanism will be correction for momentary changes in
blood pressure; for intermediate, it will be correction for varia-
tions for a brief period; and for the long term, it will be correction
leading to complete equilibrium for years. Resultantly the sources
of these outputs will be as follows (6):
1. Short-term mechanism
A. Baroreceptor reflex (60 –100 mmHg): baroreceptors are
located mainly in carotid sinus and aortic arch. The
477
Illuminations
478

Table 1. Elements of a logic model

Inputs Activities Outputs Outcomes/Impacts

What resources go into a What activities the program What is produced through those The changes or benefits that result
program undertakes activities from the program

cells are sensitive to pressure, hence the name “baro-
receptors”. When pressure rises, they send impulses to
vasomotor center (VMC) and increase the parasympa-
thetic tone to bring back the ABP to normal limits.
B. Chemoreceptor reflex (40 – 60 mmHg): tissue ischemia
stimulates peripheral chemoreceptors (carotid and aor-
tic bodies), resulting in rise in blood pressure, heart
rate, and rate and depth of respiration by stimulation of
VMC and respiratory center.
C. CNS ischemic response (15–50 mmHg): a fall in blood
pressure below 50 mmHg can directly stimulate VMC.
Resultant stimulation of sympathetic nervous system
increases heart rate, cardiac output, and blood pressure.
This phenomenon is also observed in increased intra-
cranial tension that occludes blood supply to brain due
to compression of arteries. The CNS ischemic response
thus initiated is also referred to as “Cushing’s Reflex”.
2. Intermediate-term mechanism
A. Capillary fluid shift (⫹30 to 15%): This is a simple
anatomic shift of capillary fluid to the extracellular
space whenever the blood pressure rises. The shift in
fluid leads to a decrease in blood volume and resultant
fall in pressure.
B. Stress relaxation and reverse stress relaxation: the phe-
nomenon of accommodating extra blood by relaxation
of arterial wall is known as stress relaxation, and the
process of arterial contraction due to fall in blood
volume is known as reverse stress relaxation.
3. Long-term mechanism: the long-term mechanisms are the
most effective ones in maintaining the blood pressure
within narrow range throughout life. This is brought about
by direct as well as indirect mechanisms. The direct mech-
anisms of long-term regulation are achieved mainly through
pressure diuresis and pressure natriuresis, and indirect mech-
anisms are through hormonal mechanisms. The hormonal
mechanisms bring about mechanical changes in the wall of
the renal arteries like vasoconstriction and also alter the
absorptive properties of renal tubules. The two main hor-
monal mechanisms are as follows:
A. Renin-angiotensin-aldosterone mechanism.
B. Antidiuretic hormone.
Outcome/impact. The long-term impact depends upon the
type of mechanisms causing the output. Short-term mecha-
nisms control the blood pressure for seconds to minutes.
Intermediate-term mechanisms control the pressure for minutes
to hours and long-term mechanism for years together.
Implementation Strategy and Finding
This educational project was piloted for medical students in
the first phase through convenient sampling. The undergradu-
ate intake capacity of the university is 200 students/year, who,
for teaching learning purposes, are divided into batches A and
B, with 100 students in each batch. For the present study, batch
A students were considered as an experimental group (n ⫽ 95).
Five students were absent on the day of project, and hence,
they were were not included. Batch B students were considered
as controls (n ⫽ 93). Two students were on medical leave and
five were absent (total of 7), and hence, they were not included
in the study. The objectives were as follows:

Table 2. Logic model for blood pressure regulation (color coding indicates the duration of regulation of respective
mechanisms)

Outcomes/Impacts
Inputs Process Outputs Short/Intermediate/LongTterm

General factors • Nervous regulation: sympathetic and parasympathetic • Baroreceptor (60 –100 mmHg) • Short-term/instant correction
Age system Chemoreceptor (40 –100 mmHg) (within seconds to minutes)
Sex • Intrinsic physical regulatory mechanisms CNS Ischemic response (15–50
Hereditary mmHg)
Meals • Capillary fluid shift (⫹30 to • Intermediate correction (within
Sleep 15%); stress relaxation and Re- days to 1 mo)
verse stress relaxation
Emotions • Autoregulatory Mechanisms • Renal, hormonal (RAA and anti- • Long term regulation (within days
Gravity diuretic hormone to years)
Diurnal variations
Circulatory factors • Hormonal mechanisms
Cardiac output
Peripheral Resistance
Arteriolar radius
Viscosity
Length of the vessel
(the Poiseuille-
Hagen’s law)

RAA, renin-angiotensin-aldosterone.

Advances in Physiology Education • doi:10.1152/advan.00074.2016 • http://advan.physiology.org

Downloaded from journals.physiology.org/journal/advances (202.043.093.018) on April 3, 2023.

Table 3. Feedback of experimental group (responses ⫽ 95) regarding learning ABP regulation through logic model
Serial No. Item
1 Concept of logic model is interesting.
2 Logic model will help in retaining and reproducing the concept
of arterial blood pressure regulation.
3 I would like to explore the logic model further.
ABP, arterial blood pressure; NA, not available.
1. Sensitize the experimental group about the importance
and implication of logic model.
2. Aid in the understanding of blood pressure regulation
through logic model, thereby stressing the importance and
correlation of input, process, output. and outcomes for main-
taining blood pressure within physiological limits.
3. Compare the level of understanding of blood pressure reg-
ulation between experimental group (n ⫽ 95) and controls
(n ⫽ 93).
4. Record the perception of experimental groups regarding
learning through logic model.
5. Analyze the limitations of this approach.
The experimental group (n ⫽ 95) was first briefed about
logic model (lecture based) so that they understood the concept
in a better way. They were taught about ABP regulation by
logic model, and controls were taught the same in conventional
way (n ⫽ 93). Two objectives of the class were identified. 1)
Learners should be able to enumerate various regulatory fac-
tors for ABP regulation; 2) they should be able to explain
various mechanisms that are involved in maintaining short-,
intermediate-, and long-term ABP within physiological limits.
Student perceptions of the utility of this method were col-
lected in a feedback tool with three simple close-ended items
and one open-ended item. Out of the 95 students who attended,
90.5% agreed or strongly agreed that the concept of logic
model is interesting. It was agreed by 84.1% of students that
the new approach could be helpful in retaining and reproducing
the concept of ABP regulation. Experimental group further
affirmed (91.57%) that they would like to explore the logic
model further. In response to the question, “Where else can the
principle of logic model be applied in physiology?”, 45 and
12% students mentioned regulation of respiration and hor-
monal regulation, respectively, and 43% did not comment
(Table 3). Learning on preidentified objectives (as mentioned
above) was assessed through semistructured oral examination
by four examiners on a preagreed rating scale. It had questions
and model answers pertaining to factors regulating ABP and
various mechanisms of regulation. The average score was 14
and 13.5 out of 20 for the experimental group and controls
respectively, which was not statistically significant.
We will extend this pilot study of the logic model to other
systems in physiology and design a logic model curriculum for
regulation of respiration, cardiac output, glomerular filtration,
hormonal regulation and heat regulation. The new study will be
expanded with a randomized controlled crossover design for
testing the hypothesis.
Advances in Physiology Education • doi:10.1152/advan.00074.2016 • http://advan.physiology.org
Downloaded from journals.physiology.org/journal/advances (202.043.093.018) on April 3, 2023.
Illuminations
479
Strongly Disagree/Disagree, % Neutral, % Agree/Strongly Agree, %
NA/2.1 7.36 73.68/16.84
NA/4.3 11.57 74.7/9.4
Yes: 91.57% No: 3.1% Maybe: 5.4 %
Implications of Logic Model for Blood Pressure Regulation
The proposed model will help learners understand the reg-
ulation of ABP with reference to different physiological inputs
that work together to keep it within normal limits. The logical
sequence of outcomes in terms of short-, intermediate- (control
mechanisms), and long-term regulation (regulatory mecha-
nisms) can be comprehended and retained in a better way.
Although the present short project did not give significant
results, embedding the framework of the logic model into other
parts of the physiology curriculum might aid in understanding
the significance of association between inputs and outcomes. It
can also emphasize the importance of different factors and their
interplay in attaining homeostasis.
DISCLOSURES
No conflicts of interest, financial or otherwise, are declared.
AUTHOR CONTRIBUTIONS
L.S.W. drafted manuscript; L.S.W. approved final version of manuscript;
T.k.S. conception and design of research; T.k.S. edited and revised manuscript.
REFERENCES
1. Cannon WB. The Wisdom of the Body. New York: WW Norton &
Company, 1932.
2. Cannon WB. The Way of an Investigator: A Scientist’s Experiences in
Medical Research. New York: Hafner Publishing Company, 1945.
3. Frechtling JA. Logic Modeling Methods in Program Evaluation. San
Francisco, CA: Jossey-Bass, 2007.
4. Gooch JW. Hagen-Poiseuille Equation. In: Encyclopedic Dictionary of
Polymers. New York Springer, 2011, p. 355.
5. Hellemans J, Forrez P, De Wilde R. Experiment illustrating Bernoulli’s
equation and Hagen-Poiseuille’s law. Am J Physics 48: 254 –256, 1980.
6. Jain AK. The arterial blood pressure. Textbook of Physiology, Vol I,
Edition 5. Sirmour, India: Avichal Publishing, 2012, p. 364 –367.
7. Kaplan S, Garrett K. The use of logic models by community based
initiatives. Eval Progr Plan 28: 167–172, 2005.
8. Kellogg Foundation. WK Kellogg Foundation Logic Model Development
Guide. Battle Creek, MI: W. K. Kellog Foundation, 2011.
9. Knowlton LW, Phillips CC. The Logic Model Guidebook: Better Strat-
egies for Great Results. Los Angeles, CA: Sage, 2009.
10. Leandro V, Molina C, Arenas A, Antonio Ibañez J. Use of pressure
transducers in laboratory experiments. II. Experimental verification of the
Hagen-Poiseuille law Application to viscosity measurement Electrical
analogy.Am J Physics 64: 322, 1996.
11. McLaughlin J, Jordan G. Logic models: A tool for testing your pro-
gram’s performance story. Eval Progr Plan 22: 65–72, 1999.
12. McCawley PF. The Logic Model for Program Planning and Evaluation,
CIS 109. Moscow, ID: University of Idaho Press, 2001.
13. Pfitzner J. Poiseuille and his law. Anaesthesia 31: 273–275, 1976.
14. Sianoudis A, Drakaki E. An approach to Poiseuille’s law in an under-
graduate laboratory experiment. Eur J Phys 29: 489 – 495, 2008.