REGULATION OF BLOOD

PRESSURE
DR RASHMI MISHRA
Regulation of Blood Pressure
Arterial B.P. Is controlled by several
mechanism which under physiological
condition maintain the normal mean
arterial pressure which has a narrow
range 95-100 mm of Hg.
 REGULATION OF ARTERIAL
BLOOD PRESSURE

■ Immediate
mechanism
■ Short term mechanism
■ Long term mechanism

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 Short Term Regulatory
Mechanisms:
Neural mechanisms

1.1.Baroreceptor
reflexes

2.2. Chemo receptor

reflexes
3. Cerebral ischaemic
response
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 BARORECEPTOR
REFLEX

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BARO RECEPTOR REFLEXES (MAREY’S
REFLEXES) BP

Stimulation of baroreceptors
(carotid sinus and aortic arch)

Tractus solitarius
stimulation

Inhibition of VMC Stimulation of CIC

(nucleus ambiguous)

SNS Vagus
BP
 Symp Vagal tone 
tone
Blood Vessels Heart Rate Decreased

- Vasodilatation
- Venodilatation Bradycardia
 BARORECEPTOR REFLEX

Net effect

 Peripheral resistance

 Myocardial contractility

 Heart rate
(Bradycardia)

 Fall in BP

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 Cerebral Ischaemic Response
 BP < 40 mm Hg (or)
 Intracranial
pressure

Cerebral ischaemia

Cerebral hypoxia

Direct effect on
VMC

SNS action 
Vasoconstriction
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Cushing’s Reflex
 BP with reflex
 Delayed or Intermediate Mechanism

Capillary fluid shift phenomenon:

Whenever there is an increase in blood pressure
more fluid is filtered through the capillary wall
into the interstitial space.

Blood volume decreases and so BP itself decreases.

Reverse changes take place when BP falls.

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(

Stress Relaxation
Phenomenon:
BP Blood vessels are
stretched Stress relaxation
Increased capacity
Decreased effective
blood volume relaxation of
the vessel wall BP

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REVERSE STRESS RELAXATION

 When the B.P. is low due to stress on the vessels walls and
tries to restore it back to normal.
 This mechanism can correct up to 15% change in blood
volume below normal.
 Long term Regulatory
Mechanisms:
All the
mechanisms
that tend to
alter the blood
volume
participate in
long term
regulatory
mechanisms
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RENAL BODY FLUID SYSTEM FOR
ARTERIAL PRESSURE CONTROL
 Therenal body fluid system corrects the B.P. by
causing appropriate changes in the Blood volume
through diuresis and natriuresis.

WHEN B.P RISES TOO HIGH- The kidney excrete

increased quantities of sodium and water because
of
pressure diuresis respectively.
 As a result of increased renal excretion.
The extracellular fluid volume and blood volume
both decrease until B.P return to normal and the
kidney excrete normal amount of sodium in water.
 Increases B.P. (Large intake of Water & Salt)

Increased excretion of salt & water by Kidney

Decreased in Extracellular fluid & blood volume

Decreased venous return to Heart

Decreased Cardiac output

Decreases B.P.
 WHEN THE B.P. FALLS TOO LOW

•The Kidney reduces the rate of sodium and water

excretion and over a period of hours
to day.
• If the person drinks enough water and eats enough
salt to increases blood volume the B.P. will return to
previous level.
 Renal –body fluid system:
•ECF or Blood volume
•-  BP
ECF or Blood volume

• GFR  urine output - BP

 GFR BP  urine output

•B.P is brought back to
the normal level
B.P is slowly raised to
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 Indirect Mechanism
When B.P. & extracellular fluid decreases, Renin secreted from
kidney is increased it converts Angiotensinogen into
Angiotensin I , this is converted into Angiotensin II by
ACE(Angiotensin converting enzyme). Angiotensin II act in 2
ways to restore the B.P. :-
1) This causes constriction of arteriole in the body, so
the peripheral resistance is increased and B.P. raised,
in addition Angiotensin II causes constriction of
afferent arteriole in the kidneys so the the
glomerular filtrate reduces. This return in the
retention of water and salt, increase ECF volume to
normal volume, this in turn increases the BP to the
normal level.
2) Simultaneously, Angiotensin II stimulate zona
glomerulosa of adrenal cortex to secrete aldosterone,
This hormone increases the reabsorption of Na+ from
renal tubules . Na+ is followed by water reabsorption
resulting in increased ECF volume and the blood
volume . It increases the B.P. to the normal level.
 Decrease in B.P. Normal B.P.
Stimulation
Increase in
JG Apparatus Blood Volume

Renin
Increase in ECF
Volume
Angiotensinogen Angiotensin I
ACE (Lung)
Angiotensin II Reabsorption of
Vasoconstriction water and sodium
Angiotensin III
Adrenal Cortex

Angiotensin IV
Kidney

Aldosterone
Angiotensin III

It increases the BP and stimulate adrenal cortex to

secretes aldosterone. It has 100% Adrenal stimulating
activity. And 40% vassopresor activity of Angiotensin
II.

Angiotensin IV

It also has adrenal stimulating and vassopressor

activities
 HORMONAL REGULATIONS
Catecholamines
Mineralocorticocoid
Glucocorticoid
Thyroxine
ADH
Atrial Natriuretic Factor
Nitric Oxide
Histamine
Angiotensin
Serotonin
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Local Mechanism for regulation of B.P.
 Instead of renal, nervous and hormonal regulation
some local substances regulates B.P. by
vasoconstrictor and vasodilation
Local Vasoconstrictors
They are derived from vascular endothelium.
These substances are called endothelium derived constricting
factors (EDCF).
Types of EDCF – ET1, ET2, ET3 are identified so far.
Local Vasodilators
Local vasodilators are of two types
1.Vasodilators of metabolic origin
(eg.-CO2, H+ ion, adenosine)
2.Vasodilator of endothelium
(eg.- NO(nitric oxide)
 Hypertension
❖ Defined as an elevation of systolic
blood pressure
❖ Persistent hypertension very common
❖ 30% of people over 50 are
hypertensive
❖ Never diagnosed on one reading
❖ Indication of cardiovascular disease
❖ Trauma
❖ Side effect of medication
  BP is called
(Above 140/90 mm of
Hypertension
Hg ) (Essential
Primary Secondary (10%)
90%)

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 Diseases Attributable
to Hypertension
Stroke
Coronary heart disease
Heart failure

Cerebral hemorrhage
Myocardial infarction

Left ventricular
hypertrophy Hypertension Chronic kidney failure

Hypertensive
Aortic aneurysm encephalopathy
Retinopathy
Peripheral vascular disease
All
Vascular
 Hypertension
Predisposing factors:
■ Obesity
■ Hereditary
■ Alchoholism
■ Stress
■ Smoking
■ Sedentary life
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Primary Hypertension : -
90% of patients suffer from primary hypertension of
which the cause is not known, But this is the type of
hypertension which is treatable but not curable .
- it is treated by antihypertensive drugs.
Secondary Hypertension : -.
This is the type of hypertension which is caused
secondary to some disease .
Malignant Hypertension : -
This is chronic hypertension which shows lesion in
necrotic arterioles.
- This condition is associated with Papilledema,
Cerebral Manifestation & Renal Failure.
- it is treated by antihypertensive drugs.
 Secondary Hypertension
Causes:
■1.Renal-Acute & Chronic
Glomerulonephritis,Nephrotic syndrome
■2.Endocrine-
Cushings,Conns,Thyrotoxicosis,
Pheochromacytoma
■3.Vascular-Atherosclerosis

Arteriosclerosis
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 Treatment of Hypertension
Modification of lifestyle:
■Cessation of smoking.
■Moderation in alcohol intake.

■Weight reduction.

■Programmed exercise.

■Reduction in Na+ intake.

■Diet high in K+.

■Relaxation technique – Yoga, TM

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 Treatment of Hypertension
■ Medications:
■ Diuretics:

Increase urine
■ volume.
Beta-blockers:

Decrease HR.
■ Calcium
antagonists:

Block Ca2+
■ ACEchannels.
inhibitors:

Inhibit conversion to angiotensin
 II.
Angiotension II-receptor antagonists:

Block receptors.
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 Prevention
■ Reduce the risk of developing High Blood
Pressure by making lifestyle changes…..
■ Eat a healthy , well balanced diet
■ Reduce salt and fat intake
■ Exercise regularly
■ Stop smoking
■ Reduce alcohol and caffeine consumption to
recommended levels
■ Reduce weight
 Hypotension

❖ Defined in adults as a
systolic pressure
below 100mm Hg
❖ Rarely treated in this
country
  HYPOTENSION
 A decrease in B.P. below the normal value of 90/60
mm of Hg.
 Types
1. Primary Hypotension :- It is low B.P. that
develops in the absence of any underlying
disease & develops due to unknown cause.
2. Secondary Hypotension :- It is the hypotension
that occurs due to some underlying disease
which cause hypotension-
a) Myocardial Infarction
b) Hypoactivity of pituitary gland
c) Hypoactivity of adrenal glands
d) Nervous disorders
e) Tuberculosis
  BP is called
(Below
Hypotension 90/60
mm of Hg)

1. Hemorrhage
2.Dehydration
3.Vomiting
4.Diarrhea
5.Excessive sweating
6.Adissons disease
7.Hypothyroidism

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 Treatment of
Hypotension
Treat the cause

Blood transfusion
I.V. Fluids
Vasoconstrictors

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