Arterial Blood Pressure

DEFINITIONS AND NORMAL VALUES

Arterial blood pressure is defined as the lateral pressure
exerted by the column of blood on wall of arteries.
The pressure is exerted when blood flows through the
arteries. Generally, the term ‘blood pressure’ refers to
arterial blood pressure.
Arterial blood pressure is expressed in four different
terms:
1. Systolic blood pressure
2. Diastolic blood pressure
3. Pulse pressure
4. Mean arterial blood pressure
SYSTOLIC BLOOD PRESSURE
Systolic blood pressure (systolic pressure) is defined as
the maximum pressure exerted in the arteries during
systole of heart.
Normal systolic pressure: 120 mm Hg (110 mm Hg
to 140 mm Hg).
„ DIASTOLIC BLOOD PRESSURE
Diastolic blood pressure (diastolic pressure) is defined
as the minimum pressure exerted in the arteries during
diastole of heart.
Normal diastolic pressure: 80 mm Hg (60 mm Hg to
80 mm Hg).
PULSE PRESSURE
Pulse pressure is the difference between the systolic
pressure and diastolic pressure.
Normal pulse pressure: 40 mm Hg (120 – 80 = 40).

MEAN ARTERIAL BLOOD PRESSURE

Mean arterial blood pressure is the average pressure existing
in the arteries. It is not the arithmetic mean of systolic and
diastolic pressures. It is the diastolic pressure plus one third
of pulse pressure. Normal mean arterial pressure: 93 mm Hg
(80 + 13= 93).
Formula to calculate mean arterial blood pressure:
Mean arterial blood pressure
= Diastolic pressure + 1/3 of pulse pressure
 DETERMINANTS OF ARTERIAL BLOOD PRESSURE –
FACTORS MAINTAINING ARTERIAL BLOOD PRESSURE
 REGULATION OF ARTERIAL
BLOOD PRESSURE

Arterial blood pressure varies even under physiological

conditions. However, immediately it is brought back to
normal level because of the presence of well organized
regulatory mechanisms in the body. Body has four such
regulatory mechanisms to maintain the blood pressure
within normal limits:
A. Nervous mechanism or short term regulatory mechanism
B. Renal mechanism or longterm regulatory mechanism
C. Hormonal mechanism
D. Local mechanism.
 NERVOUS MECHANISM FOR REGULATION OF BLOOD
PRESSURE –SHORT-TERM REGULATION

Nervous regulation is rapid among all the mechanisms involved

in the regulation of arterial blood pressure. When the pressure
is altered, nervous system brings the pressure back to normal
within few minutes. Although nervous mechanism is quick in
action, it operates only for a short period and then it adapts to
the new pressure. Hence, it is called short term regulation. The
nervous mechanism regulating the arterial blood pressure
operates through the vasomotor system.
• Vasomotor System
• Vasomotor system includes three components:
• 1. Vasomotor center
• 2. Vasoconstrictor fibers
• 3. Vasodilator fibers
VASOMOTOR CENTER
Vasomotor center is bilaterally situated in the reticular formation of
medulla oblongata and the lower part of the pons.
Vasomotor center consists of three areas:
i. Vasoconstrictor area
ii. Vasodilator area
iii. Sensory area.

VASOCONSTRICTOR FIBERS
Vasoconstrictor fibers belong to the sympathetic division of
autonomic nervous system. These fibers cause vasoconstriction by the
release of neurotransmitter substance, noradrenaline. Noradrenaline
acts through alpha receptors of smooth muscle fibers in blood vessels.
Vasoconstrictor fibers play major role than the vasodilator fibers in
the regulation of blood pressure
 VASODILATOR FIBERS

Vasodilator fibers are of three types:

i. Parasympathetic vasodilator fibers
ii. Sympathetic vasodilator fibers
Iii. Antidromic vasodilator fibers.
MECHANISM OF ACTION OF VASOMOTOR CENTER IN
THE REGULATION OF BLOOD PRESSURE

Vasomotor center regulates the arterial blood pressure

by causing vasoconstriction or vasodilatation. However,
its actions depend upon the impulses it receives from
other structures such as baroreceptors,
chemoreceptors,
higher centers and respiratory centers. Among these
structures, baroreceptors and chemoreceptors play a
major role in the shortterm
regulation of blood pressure
1. Baroreceptor Mechanism
Baroreceptors are the receptors, which give response
to change in blood pressure. Baroreceptors are also
called pressoreceptors.
2. Chemoreceptor Mechanism
Chemoreceptors are the receptors giving response to
change in chemical constituents of blood. Peripheral
chemoreceptors influence the vasomotor center.
 HORMONAL MECHANISM FOR
REGULATION OF BLOOD PRESSURE
 MEASUREMENT OF ARTERIAL BLOOD PRESSURE
Blood pressure is measured by two methods:
• A. Direct method
• B. Indirect method.
INDIRECT METHOD
Indirect method is used to measure arterial blood pressure in man as
well as in animals.
Apparatus
Apparatus used to measure blood pressure in human beings is called
sphygmomanometer. Along with sphygmomanometer, stethoscope is
also necessary to measure blood pressure.
Principle
When an external pressure is applied over the artery, the blood flow
through it is obstructed. And the pressure required to cause occlusion
of blood flow indicates the pressure inside the vessel.
Procedure
Brachial artery is usually chosen because of convenience. The arm
cuff of sphygmomanometer is tied around upper arm, above the
cubital fossa. Cuff should not be too tight or too loose. It is connected
to sphygmomanometer. Now, blood pressure can be measured by
three methods.
1. Palpatory method
2. Auscultatory method
3. Oscillatory method.

1. Palpatory method
First, the radial pulse is felt. While feeling the pulse, pressure is
increased in the cuff by inflating air into it, with the help of a hand
pump. While doing this, mercury column in the sphygmomanometer
shows the pressure in the cuff. When pressure is increased in the arm
cuff, brachial artery is compressed and blood flow is obstructed.
so, radial pulse disappears. When radial pulse
disappears,
the pressure is further increased by about 20 mm Hg.
Then, the pressure in the cuff is slowly reduced by
releasing the valve of the hand pump, i.e. the cuff is
deflated slowly. This is done by feeling the pulse and
simultaneously watching the mercury column in the
apparatus. Pressure is noted when the pulse
reappears.
This pressure indicates the systolic pressure.
Disadvantage of palpatory method is that the
diastolic pressure cannot be measured.
2. Auscultatory method
Auscultatory method is the most accurate method to
determine arterial blood pressure. After determining
the systolic pressure in palpatory method, the pressure
in the cuff is raised by about 20 mm Hg above that
level, so that the brachial artery is occluded due to
compression. Now, the chest piece of the stethoscope
is placed over the antecubital fossa and the arm cuff
is slowly deflated. While doing so, series of sounds
are heard through the stethoscope. These sounds
are known as Korotkoff sounds, named after the
discoverer Korotkoff (1905).
 3. Oscillatory method
When pressure in the arm cuff is increased above the
level of systolic pressure, the artery is occluded due
to compression. At this stage, the mercury column in
the manometer remains static. When the pressure is
gradually reduced, some oscillations occur at the top of
the mercury column. While deflating the cuff further, the
amplitude and duration of oscillations increase suddenly.
It denotes systolic pressure. When the cuff pressure is
reduced further, the amplitude and duration of oscillations
is reduced. It reflects the diastolic pressure.