1.

Hydrostatic Effect on BP
Median Age - 22 (IQR = 2)
Mean Heignt 172.4 cm sd=8.7
Mean Weight = 69 kg sd = 13.8
Males = 46%
Females = 54%
Semi-automatic:
- Sys = 112
- Dias = 65
wk2:
-113/63
- heaps of variance wk1 vs wk2 (some stayed the same) - natural variation
- c.f. w1 SBP - larger range, much variation
Finometer:
- 116/61
SBP:
- males skewed higher (140 to 90)
- females (120-80)
SBP vs Weight:
- w/ regression analysis
- some outliers + above average
- some ppl w/ above average weight have low BP, and some w/ low weight have ^ BP
Arm BP:
- raise arm - subtract P
- lower arm - add P
- head to heart = 40cm = 400mm
- 1mmHg : 12mmH2O
- 30mmHg: 400mmH2O
MAP @ Post Tibial (@ ankle)
- 210 mmHg systolic
- ankle capillaries --> high BP --> damage BV/distension
- but BV don't blow up
BP @ scalp arteries
- around 90mmHg
- scalp capillaries --> low BP --> less blood flow --> abnormal starling forces
- but don't get blood flow starvation
What factors ensure capillary hydrostatic P maintained optimally, despite change
s in main MAP
Resistance arteries/arterioles
- dilate
- let more blood in; prevent high P from restricting arteries
- TPR determines P of arteries in (scalp)
- vasoconstriction of scalp arteries has imperceptible effect on TPR
- for leg arteries - constrict to protect capillaries from high pressures
What is the overall term that describes such mechanisms:

Autoregulation (ref. Harrap's 2nd year renal lectures HSF)

- via stretch on SM cells -> detect --> constrict to increase resistance (protec
t capillary bed)
- independent of ANS, hormones and endothelium
Raise arm - low P - stop bleed
- can't hold stuff above head for long
Scalp Bleed
- bleed lots from tiny cut
- arteries weak, used to dilating + connective tissue to hold vessels open
- P in capillaries --> more filter than reabs --> edema
Hot day:
- more vasodilate
- more P in leg capillaries
- swell up
Some Drugs:
- impair constriction of resistance arteries
- ankle edema (common side effect of Ca2+ blockers)
- Ca2+ channel blockers and other vasodilators
- headache (GTN)
Standing for 2 min:
- lying = 116/61; pp=55
- standing = 105/63 pp=42
- narrowing pulse pressure
- standing - smaller arterial pulse wave
Why does pulse pressure fall?
- SV det PP (^SV, more bp excursion)
- compliance (_ compliance; ^ PP)
- reflected waves
Pulse Wave:
++++ ---------------------->
+++
heart ______________________________resistance arteries
<---+ reflected wave
waves cross --> interference;
- important @ start of aorta
- position of coronary arteries
- primary wave meets returning wave during diastole
- hence extra hump at diastolic waveform in aorta
- extra pressure needed to fill coronary arteries (when heart relaxed)
Systole
- summated wave --> higher P
- means heart has to generate more P
- coronaries not getting reflected wave augmenting diastolic filling
What happens to MAP
- 79 lying
- 77 standing
- MAP = CO x TPR
SV:
- determines CO
- drops

CO:
- lowered
- compensate - TPR + ^ HR
Immediate Effects of Standing:
- supine 115/64
- first 30 sec - 71/65
- hr - 71 --> 106
- drop CO
- SV falls 94 -> 54
- TPR - 997 -> 596
On standing:
- muscles contract (not w/ tilt table) --> muscle pump effect
- ^ central blood vol & filling of central veins
- ^ cardiac filling
- SV maintained
- HR rises
- CO rises
- TPR stable
- TPR falls = Cardiopulmonary Reflext
- heart filled more than normal
- heart stretch receptors activated --> oppose high CO
- vasodilate to prevent ^ MAP
- + Muscles
- vasodilation for exercise + local metabolites
- TPR wrongly predicted that CO ^
- muscles relax - blood cleared by heart falls down or cleared by heart
- central veins emptied
- dependent veins fill
- SV falls
- CO falls
- BP falls and bottoms out --> detected by baroreflex
Baroreflex Responds:
- TPR rises
- BP rises
Effects of GTN:
- general decrease in SBP and DBP (a little)
- change in pulse pressure roughly the same
- HR difference increased
- to compensate for larger fall in CO (or maintained)
- predominantly due to greater reduction in SV after standing up
On standing with GTN:
- massive drops in SBP and DBP
- peripheral vein dilated more blood pools in feet
- less CO and BP, higher HR
Low P
- arteries in brain dilate to max
- feel dizzy
- more for tall ppl (larger pressure differential)
Perceived High SBP from automated machines:
- doctor vs patient - mis-report + don't want to upset patient + don't want to d
eal with prescribing life-long drugs
- using a mercury machine - can't hear SBP until get to certain point (muffling;

or doctor is deaf)
some expiration effect
speed - let air out too fast (missed 1st beat); in a rush
fudging/rounding numbers (5 or 0 on end) - ppl tend to round down.
bias - pre-determine signs going to find based on experience