Blood pressure

Dr. Dev K Shah

Assistant Professor
Dept of Physiology
 Blood pressure
It is lateral pressure exerted by column of blood
on the wall of blood vessels.

Blood pressure = Cardiac output X Peripheral resistance

 Systolic pressure = 100 - 140 mmHg
Diastolic pressure = 60 - 90 mmHg

Pulse Pressure = Systolic – Diastolic

= 20-50 mmHg

Mean Pressure = 2/3rd of Diastolic + 1/3rd Systolic

= Diastolic + 1/3rd Pulse Pressure
= 75-105 mmHg

Pulmonary systolic pressure = 25 mmHg

Pulmonary diastolic pressure = 8 mmHg
Mean pulmonary arterial pressure = 16 mmHg
Factors responsible for BP
 Regulation of BP
Short term regulation Long term regulation
- Within secs or mins. - after hours.
- Mainly by neural - Mainly by changes in
mechanism. fluid volume by
• Baroreceptor reflex  Hormonal mechanism:
• Chemoreceptor reflex • Renin-angiotensin-
• CNS ischemic aldosterone system.
response/Cushing reflex • ADH
• Capillary fluid shift • ANP
• Stress relaxation  Renal mechanism.
 Baroreceptor reflex
• Regulates the BP in range of 70 -150 mmHg.
 Chemoreceptor reflex
• Regulate BP in range of 40-70 mmHg.
Hypoxia

Stimulation of chemoreceptors (carotid body and aortic bodies)

Stimulation of cardio inhibitory and vasomotor centers in medulla.

• Results in bradycardia and vasoconstriction (primary effects).

• Also causes hyperventilation and catecholamines secretion

from adrenal medulla which increases heart rate
(secondary effects).
 CNS ischemic response
• Occurs when BP falls below 40 mmHg.
Severe hypotension

Decrease in blood flow to brain.

Hypoxia and hypercapnia of vasomotor center.

Stimulation of vasomotor center.

Vasoconstriction

Return of pressure back to normal.

 Cushing reflex
Increase in intracranial pressure.

Compression of blood vessels supplying vasomotor center.

Decrease in blood supply to vasomotor center.

Stimulation of vasomotor center.

Intense vasoconstriction.

Increase in BP.

Activation of baroreceptor reflex and bradycardia.

 Capillary fluid shift
Increase in BP.

Increase in hydrostatic pressure in capillaries.

Shift of fluid from intravascular compartment to interstitial

space (extravascular compartment).

Decrease in circulating blood volume.

Decrease in BP to normal.
 Stress relaxation
Sudden increase in BP.

Stretching of smooth muscles of blood vessels.

Relaxation of smooth muscles.

Decrease in vascular tone.

Decrease in BP back to normal.

 Renin-Angiotensin-Aldosterone system
Fall in BP

Release of renin from JG cells of kidney.

Angiotensinogen angiotensin I  angiotensin II

• vasoconstriction
• increases Na+ and H2O reabsorption from kidney.
• increases the synthesis and secretion of aldosterone from adrenal
gland.

Increases Na+ and H2O reabsorption from kidney.

 ADH
Decrease in BP due to decrease in blood volume.

Secretion of ADH from posterior pituitary.

Increase H2O reabsorption from kidney.

Increase in blood volume.

Increase in BP.
 ANP
Increase in BP due to increase in blood volume.

Increase in venous return.

Stretching of right atrial myocytes.

Release of ANP.

Natriuresis and diuresis.

Decrease in blood volume.

Decrease in BP.
 Physiological variations
• Age
• Gender
• Eating
• Sleep
• Emotion and excitement
• Exercise
• Posture
• Temperature
• Pregnancy
 Hypotension
• Systolic blood pressure less than 90 mmHg and
diastolic less than 60 mmHg.
Causes:
• Hemorrhage
• Diarrhea
• Vomiting
• Excessive diuresis
• Hypopituitarism
• Adrenocortical insufficiency
• MI
• Malnutrition
 Hypertension
• Sustained elevation of systemic arterial pressure.
 Types of hypertension

• Essential hypertension (95%)

• Secondary hypertension (5%)
Causes:
• Renal disease
• Endocrine disease
• Drugs
• Coarctation of aorta
• Pregnancy (pre-eclampsia)
 Effects of hypertension
• On heart:
Persistent increase in peripheral resistance (after load).

Excessive work load on heart.

Left ventricular hypertrophy (increase in wall thickness).

Afterwards dilatation of ventricular cavity.

Myocardial O2 requirement also increases.

Angina pectoralis and ischemic heart disease.

Deterioration of cardiac functions.
Initiation of heart failure.
• On blood vessels:
Chronic wall stress.

• Thickening of internal elastic lamina.

• Hypertrophy of smooth muscle.
• Deposition of fibrous tissue.

Stiffness of vessel wall (decreased vascular compliance).

Further aggravation of hypertension.

Increased chance of atherosclerosis.

• On retina
• On kidney
• On CNS
 Physiological basis of management of hypertension

• Weight reduction
• Dietary modification
 Salt restriction
 Fat restriction
 Increased fiber content in diet
• Regular physical exercise
• Mental relaxation
 Change in temperament (remaining cool and less aggressive)
 Relaxation therapy (meditation, listening soothing music)
 Yoga therapy
• Stoppage of alcohol and smoking
• Antihypertensive drugs
Thank you