Blood Pressure and

Pathophysiology of
Hypertension
(Short and Long Term
Regulation of BP)
Short-Term Regulation of Blood
Pressure:

• Baroreceptors are sensory receptors

sensitive to stretch. Baroreceptors
are located in the carotid sinuses and
the aortic arch. The baroreceptor
reflex changes peripheral resistance,
heart rate, and stroke volume in
response to changes in blood
pressure.
 Chemoreceptors are sensory
receptors sensitive to oxygen,
carbon dioxide, and pH levels in the
blood.
 The CNS ischemic response
results from high carbon dioxide or
low pH levels in the medulla and
increases peripheral resistance.
Thus it increases BP. This is clearly
observed in some patients suffering
from ischemic attacks.
• Adrenalin and noradrenalin are
released from the adrenal medulla as a
result of sympathetic stimulation. They
increase heart rate, stroke volume, and
vasoconstriction.
• Renin is released by the kidneys in
response to low blood pressure. Renin
promotes the production of angiotensin
II, which causes vasoconstriction and an
increase in aldosterone secretion.
 ADH released from the posterior
pituitary causes vasoconstriction, raising
blood pressure.
 Atrial natriuretic hormone is released
from the heart when atrial blood pressure
increases. It stimulates an increased
urinary production, causing a decrease in
blood volume and blood pressure.
 Fluid shift is a movement of fluid from
the interstitial fluid to maintain blood
volume.
 The stress—relaxation response is an
adjustment of the muscles of blood
vessels in response to a change in the
volume.
 LONG-TERM REGULATION OF BLOOD
PRESSURE
 The kidneys regulate blood pressure by
controlling blood volume. In response to an
increase in blood volume, the kidneys
produce more urine and decrease blood
volume. Renin angiotensin II, aldosterone,
vasopressin, atrial natriuretic hormone, and
sympathetic stimulation play a role in
controlling urinary volume.
 LONG-TERM REGULATION OF BLOOD
PRESSURE
 The kidneys regulate blood pressure by
controlling blood volume. In response to
an increase in blood volume, the kidneys
produce more urine and decrease blood
volume. Renin angiotensin II, aldosterone,
vasopressin, atrial natriuretic hormone,
and sympathetic stimulation play a role in
controlling urinary volume.
 LONG-TERM REGULATION OF BLOOD
PRESSURE
 The kidneys regulate blood pressure by
controlling blood volume. In response to
an increase in blood volume, the kidneys
produce more urine and decrease blood
volume. Renin angiotensin II, aldosterone,
vasopressin, atrial natriuretic hormone,
and sympathetic stimulation play a role in
controlling urinary volume.
 Fluid shift and stress-relaxation
responses help control pressure.
 Blood Pressure and the Effect of
Gravity
 In a standing person hydrostatic
pressure caused by gravity increases
blood pressure below the heart and
decreases pressure above the heart.
Control of Blood Flow in Tissues:

 Local Control of Blood Flow by the Tissues

 Blood flow through a tissue is usually proportional to the
metabolic needs of the tissue. Exceptions are tissues
that perform functions that require additional blood.
 Control of blood flow by the metarterioles and
precapillar’y sphincters can be regulated by
vasodilator substances or by lack of nutrients.
 Only large changes in blood pressure have an effect on
blood flow through tissues.
 If the metabolic activity of a tissue increases, the
number and the diameter of capillaries in the tissue
increase over time.
 Nervous and Hormonal Regulation of Local
Circulation:
 1. The sympathetic nervous system (vasomotor
center in the medulla) controls blood vessel
diameter. Other brain areas can excite or inhibit
the vasomotor center.
 2. Vasomotor tone is a state of partial
contraction of blood vessels.
 3. The nervous system is responsible for routing
the flow of blood and maintaining blood
pressure.
 4. Sympathetic action potentials stimulate
adrenalin and noradrenalin release from the
adrenal medulla and these hormones cause
vasoconstriction in most blood vessels.
 REGULATION OF MEAN ARTERIAL PRESSURE

 Mean Arterial pressure (MAP) is

proportional to cardiac output
times the peripheral resistance.
 MAP = CO X PR
 MAP = DBP + (Pulse pressure /3)
 Pulse Pressure = SBP - DBP