Chapter

20

2012 Pearson Education, Inc.

Pengaturan
Tekanan Darah

Tujuan pembelajaran
1. Mahasiswa mampu menjelaskan mekanisme
pengaturan tekanan darah
2. Mahasiswa mampu menjelaskan pengaruh sistem
saraf dan hormon pada jantung

Function of Arteries
Vasoconstriction and Vasodilation
Affect:
1. Afterload on heart
2. Peripheral blood pressure
3. Capillary blood flow

Function of Arteries
Artery Diameter
Change with sympathetic or endocrine stimulation
Constricted arteries oppose blood flow
Resistance (R)
Resistance vessels - arterioles

Blood Vessels
The Distribution of Blood
Heart, arteries, and capillaries
3035% of blood volume

Venous system
6065%
1/3 of venous blood is in the large venous networks
of the liver, bone marrow, and skin

Figure 21-7 The Distribution of Blood in the Cardiovascular System

3%
ar
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rie
s
m
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ar
y

64
%

Pu
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s
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yv

4%

Heart 7%

em
ic
art
eri
al
sys
tem
13%

7%

Sy
st

ies
llar

Ar
te
rio
le
s

2%

Aorta
2%
Ela
stic
Mu
ar t e
sc
ries
ul
4%
ar
ar
te
rie
s5
%

c
mi 7%
e
t
s
Sy laries
il
cap

ic venous sys
tem
System

r
lm
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Pu lmo
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cap
mic
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Venules and
medium-sized veins
25%

p
ca

2%

7
Heart

Large venous
networks (liver,
bone marrow, skin)
21%

y
ar
on

s
rie
a
ill

y
ar
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lm it
Pu ircu
c

Large veins
18%

21-1 Blood Vessels

Capacitance of a Blood Vessel
The ability to stretch
Relationship between blood volume and blood
pressure
Veins (capacitance vessels) stretch more than
arteries

21-1 Blood Vessels

Venous Response to Blood Loss
Vasomotor centers stimulate sympathetic nerves
1. Systemic veins constrict (venoconstriction)
2. Veins in liver, skin, and lungs redistribute venous
reserve

21-2 Pressure and Resistance

Total Capillary Blood Flow
Equals cardiac output
Is determined by:
Pressure (P) and resistance (R) in the
cardiovascular system

Figure 21-8 An Overview of Cardiovascular Physiology

Cardiac Output

Venous Return

Arterial Blood
Pressure

Regulation
(Neural and Hormonal)

Venous
Pressure

Peripheral
Resistance

Capillary Pressure

Capillary
exchange
Interstitial fluid

21-2 Pressure and Resistance

Pressure (P)
The heart generates P to overcome resistance
Absolute pressure is less important than pressure
gradient
The Pressure Gradient (P)
Circulatory pressure

The difference between:

Pressure at the heart
And pressure at peripheral capillary beds

21-2 Pressure and Resistance

Flow (F)
Is proportional to the pressure difference (P)
Divided by R

21-2 Pressure and Resistance

Measuring Pressure
1. Blood pressure (BP)
Arterial pressure (mm Hg)

2. Capillary hydrostatic pressure (CHP)

Pressure within the capillary beds

3. Venous pressure
Pressure in the venous system

21-2 Pressure and Resistance

Circulatory Pressure
P across the systemic circuit (about 100 mm Hg)
Circulatory pressure must overcome total peripheral
resistance
R of entire cardiovascular system

21-2 Pressure and Resistance

Total Peripheral Resistance
Vascular resistance
Blood viscosity
Turbulence

21-2 Pressure and Resistance

Vascular Resistance
Due to friction between blood and vessel walls
Depends on vessel length and vessel diameter
Adult vessel length is constant
Vessel diameter varies by vasodilation and
vasoconstriction
R increases exponentially as vessel diameter
decreases

21-2 Pressure and Resistance

Viscosity
R caused by molecules and suspended materials
in a liquid
Whole blood viscosity is about four times that of
water

21-2 Pressure and Resistance

Turbulence
Swirling action that disturbs smooth flow of liquid
Occurs in heart chambers and great vessels
Atherosclerotic plaques cause abnormal turbulence

Table 21-1 Key Terms and Relationships Pertaining to Blood Circulation

Table 21-1 Key Terms and Relationships Pertaining to Blood Circulation

Table 21-1 Key Terms and Relationships Pertaining to Blood Circulation

21-2 Pressure and Resistance

An Overview of Cardiovascular Pressures
Vessel diameters
Total cross-sectional areas
Pressures
Velocity of blood flow

Figure 21-10a Relationships among Vessel Diameter, Cross-Sectional Area, Blood Pressure, and
Blood Velocity within the Systemic Circuit

Vessel
diameter
(cm)

Vessel diameter

Figure 21-10b Relationships among Vessel Diameter, Cross-Sectional Area, Blood Pressure, and
Blood Velocity within the Systemic Circuit

Crosssectional
area
(cm2)

Total cross-sectional area of vessels

Figure 21-10c Relationships among Vessel Diameter, Cross-Sectional Area, Blood Pressure, and
Blood Velocity within the Systemic Circuit

Average
blood
pressure
(mm Hg)

Average blood pressure

Figure 21-10d Relationships among Vessel Diameter, Cross-Sectional Area, Blood Pressure, and
Blood Velocity within the Systemic Circuit

Velocity
of blood
flow
(cm/sec)

Velocity of blood flow

21-2 Pressure and Resistance

Arterial Blood Pressure
Systolic pressure
Peak arterial pressure during ventricular systole
Diastolic pressure
Minimum arterial pressure during diastole

21-2 Pressure and Resistance

Arterial Blood Pressure
Pulse pressure
Difference between systolic pressure and diastolic
pressure
Mean arterial pressure (MAP)
MAP = diastolic pressure + 1/3 pulse pressure

21-2 Pressure and Resistance

Abnormal Blood Pressure
Normal = 120/80
Hypertension
Abnormally high blood pressure
Greater than 140/90

Hypotension
Abnormally low blood pressure

21-2 Pressure and Resistance

Elastic Rebound
Arterial walls
Stretch during systole
Rebound (recoil to original shape) during diastole
Keep blood moving during diastole

21-2 Pressure and Resistance

Pressures in Small Arteries and Arterioles
Pressure and distance
MAP and pulse pressure decrease with distance from
heart
Blood pressure decreases with friction

21-2 Pressure and Resistance

Venous Pressure and Venous Return
Determines the amount of blood arriving at right atrium
each minute
Low effective pressure in venous system

21-2 Pressure and Resistance

Venous Pressure and Venous Return
Low venous resistance is assisted by:
Muscular compression of peripheral veins
Compression of skeletal muscles pushes blood
toward heart (one-way valves)
The respiratory pump
Thoracic cavity action
Inhaling decreases thoracic pressure
Exhaling raises thoracic pressure

21-2 Pressure and Resistance

Capillary Pressures and Capillary Exchange
Vital to homeostasis
Moves materials across capillary walls by:
Diffusion
Filtration
Reabsorption

21-3 Cardiovascular Regulation

Tissue Perfusion
Blood flow through the tissues
Carries O2 and nutrients to tissues and organs
Carries CO2 and wastes away
Is affected by:
1. Cardiac output
2. Peripheral resistance
3. Blood pressure

21-3 Cardiovascular Regulation

Cardiovascular Regulation Changes Blood
Flow to a Specific Area
1. At an appropriate time
2. In the right area
3. Without changing blood pressure and blood flow
to vital organs

Hypertension. 1991 Aug;18(2):199-210.

21-3 Cardiovascular Regulation

Controlling Cardiac Output and Blood Pressure
Autoregulation
Causes immediate, localized homeostatic adjustments

Neural mechanisms
Respond quickly to changes at specific sites

Endocrine mechanisms
Direct long-term changes

21-3 Cardiovascular Regulation

Autoregulation of Blood Flow within Tissues
Adjusted by peripheral resistance while cardiac output
stays the same
Local vasodilators accelerate blood flow at tissue
level

Low O2 or high CO2 levels

Low pH (acids)

Nitric oxide (NO)

High K+ or H+ concentrations

Chemicals released by inflammation (histamine)

Elevated local temperature

21-3 Cardiovascular Regulation

Autoregulation of Blood Flow within Tissues
Adjusted by peripheral resistance while cardiac output
stays the same
Local vasoconstrictors
Examples: prostaglandins and thromboxanes
Released by damaged tissues
Constrict precapillary sphincters
Affect a single capillary bed

21-3 Cardiovascular Regulation

Neural Mechanisms
Cardiovascular (CV) centers of the medulla oblongata
Cardiac centers
Cardioacceleratory center increases cardiac
output
Cardioinhibitory center reduces cardiac output

21-3 Cardiovascular Regulation

Vasomotor Center
1. Control of vasoconstriction
Controlled by adrenergic nerves (NE)
Stimulates smooth muscle contraction in arteriole walls

2. Control of vasodilation
Controlled by cholinergic nerves (NO)
Relaxes smooth muscle

Vasomotor Tone
. Produced by constant action of sympathetic
vasoconstrictor nerves

21-3 Cardiovascular Regulation

Reflex Control of Cardiovascular Function
Cardiovascular centers monitor arterial blood
Baroreceptor reflexes
Respond to changes in blood pressure
Chemoreceptor reflexes
Respond to changes in chemical composition,
particularly pH and dissolved gases

21-3 Cardiovascular Regulation

Baroreceptor Reflexes
Stretch receptors in walls of:
1. Carotid sinuses (maintain blood flow to brain)
2. Aortic sinuses (monitor start of systemic circuit)
3. Right atrium (monitors end of systemic circuit)

21-3 Cardiovascular Regulation

Baroreceptor Reflexes
When blood pressure rises, CV centers:
1. Decrease cardiac output
2. Cause peripheral vasodilation
When blood pressure falls, CV centers:
1. Increase cardiac output
2. Cause peripheral vasoconstriction

21-3 Cardiovascular Regulation

Chemoreceptor Reflexes
Peripheral chemoreceptors in carotid bodies and
aortic bodies monitor blood
Central chemoreceptors below medulla oblongata:
Monitor cerebrospinal fluid
Control respiratory function
Control blood flow to brain

21-3 Cardiovascular Regulation

Chemoreceptor Reflexes
Changes in pH, O2, and CO2 concentrations
Produced by coordinating cardiovascular and
respiratory activities

21-3 Cardiovascular Regulation

CNS Activities and the Cardiovascular
Centers
Thought processes and emotional states can
elevate blood pressure by:
Cardiac stimulation and vasoconstriction

21-3 Cardiovascular Regulation

Hormones and Cardiovascular Regulation
Hormones have short-term and long-term effects
on cardiovascular regulation
For example, E and NE from adrenal medullae
stimulate cardiac output and peripheral
vasoconstriction

21-3 Cardiovascular Regulation

Antidiuretic Hormone (ADH)
Released by neurohypophysis (posterior lobe of pituitary)
Elevates blood pressure
Reduces water loss at kidneys
ADH responds to:
Low blood volume
High plasma osmotic concentration
Circulating angiotensin II

21-3 Cardiovascular Regulation

Angiotensin II
Responds to fall in renal blood pressure
Stimulates:
1. Aldosterone production
2. ADH production
3. Thirst
4. Cardiac output and peripheral vasoconstriction

21-3 Cardiovascular Regulation

Erythropoietin (EPO)
Released at kidneys
Responds to low blood pressure, low O2 content in
blood
Stimulates red blood cell production

21-3 Cardiovascular Regulation

Natriuretic Peptides
Atrial natriuretic peptide (ANP)
Produced by cells in right atrium

Brain natriuretic peptide (BNP)

Produced by ventricular muscle cells

Respond to excessive diastolic stretching

Lower blood volume and blood pressure
Reduce stress on heart