Blood pressure

Physics and physiology

Goal of the
Cardiovascular System:
deliver blood to all
parts of the body
•Does so by using
different types of
tubing, attached to a
pulsatile pump
•Elastic
arteries
•Muscular
arteries
•Arterioles
•Capillaries
•Venuoles
•Veins
•Distribution system
broken up into areas
called vascular beds
•Skin
 Why does blood flow through this closed circuit?

•Blood flows down a pressure gradient

•The absolute value of the pressure is not important to flow, but the
difference in pressure (DP or gradient) is important to determining flow.

The resulting pressure is called the driving pressure in the vascular system
Structure of vasculature changes in response to different needs
Vascular system possesses different mechanisms for promoting continuous flow
of blood to the capillaries:
Elastic recoil smooth m. regulation of diameter sphincters
valves
Muscular arteries
 Systole and Diastole

The arteries fluctuate between a state of



systole and diastole


In systole, the pressure in the arteries
increases as the heart pumps blood into the
arterial system
As the pressure increases, the elastic walls of


the arteries stretch


This can be felt as a pulse in certain arteries

 Systole and Diastole


In diastole, the recoil of the elastic arteries
forces blood out of the arterial system into the
capillaries

The pressure in the arteries falls as blood
leaves the system

Minimum diastolic pressure is typically 70-80
mmHg

Maximum systolic pressure is typically 110-120
mmHg

 Blood pressure (BP)

A constant flow of blood is necessary to



transport oxygen to the cells of the body

The arteries maintain an average blood


pressure of around 90 mmHg


This helps push the blood from the arteries
into the capillaries
In the capillaries, oxygen transfers from the


blood to the cells


 Put another way
Think of the arterial system as a long balloon that you


are trying to blow up. Unfortunately the balloon has an

hole in the end…



However, as long as the puff going in is equal to the air
leaking out, the balloon remains inflated (BP is
maintained)
 Resistance = tendency of the vascular system to oppose flow
•Influenced by: length of the tube (L), radius of the tube (r), and viscosity of
the blood (η )
Poiseuille’sLaw R = Lη /r
4

•In a normal human, length of the system is fixed, so blood viscosity and radius
of the blood vessels have the largest effects on resistance
 P1 > P 2
P1 FLOW P2

mm Hg
P = FLOW x R

FLOW = P
R
P
R =
FLOW
L/min
or mm Hg
ml/sec ml/sec

Peripheral Resistance Units (PRU)

Determinants of Blood Pressure
Pressure drop is greatest at the level of the


arterioles.


Velocity of blood is slowest at the capillaries



Turbulence: The higher the velocity of blood



flow, the greater the likelihood of turbulence.



Arterial Elasticity (The Windkessel Effect):



Arterial Elasticity accounts for a smaller pulse

pressure.
Thus, atherosclerosis ------> Larger Pulse

PRELOAD: The diastolic filling pressure, or end-


diastolic volume.


AFTERLOAD: Ventricular systolic pressure, which is



equal to arterial systolic pressure under normal

circumstances.



LAPLACE'S LAW: The stress on the ventricular wall
is proportional to the Ventricular Pressure x
Ventricular Radius, where the size of the ventricle is
determined by stretching, i.e. by ventricular volume.



STARLING'S LAW OF THE HEART: Within limits,
increases in end-diastolic volume result in a
corresponding increase in stroke volume.
 BLOOD PRESSURE AND THE
RESPIRATORY CYCLE



INSPIRATION: Systemic blood pressure goes down and
pulmonary blood pressure goes up.

o The Diaphragm moving down has two effects:

It increases the volume of thoracic airspace and so it
decreases intrathoracic pressure.

Also the abdominal space becomes smaller, so it increases
intra-abdominal pressure.

The combination of above two effects results in an increased
pressure gradient for venous return from the

IVC ------> increased venous return ------> More blood to
right atrium and more blood to pulmonary

circulation ------> less respective blood in left heart and less
CO.
 BLOOD PRESSURE AND THE
RESPIRATORY CYCLE



Thus overall result is the following:

Lower systemic pressure.

Higher pulmonary pressure.

Larger Blood Volume in pulmonary circulation.

The change in MABP from inspiration normally does
not exceed 10 mm Hg.

EXPIRATION: Has the exact opposite effect.

o Pulmonary pressure decreases.

o Systemic pressure increases.
 PRESSURES IN PERIPHERY -vs- AORTA

Mean Arterial Pressure is slightly higher in the



Aorta than in, for example, the radial artery.


But, Pulse Pressure is greater in the periphery,
i.e. the systolic is higher and the diastolic is
lower.
This effect in the periphery is due to


constructive interference of reflected waves.


 COMPLIANCE: The degree to which a pressure
change leads to a corresponding change in volume

Compliance = ΔV /ΔP, or the slope of a



pressure-volume curve.


VENOUS COMPLIANCE is about twenty times



more than arterial compliance, therefore veins

can hold a larger volume of fluid at lower
pressure.
Arterial Compliance is about 2.5 mL / mm Hg


Venous Compliance is about 60 mL / mm Hg




 VASCULAR COMPLIANCE

C =
V
Arteries P250 ml =2.5 ml/mmHg
Ca=
100- 100 mmHg
Sym
Cv= 300 ml = 60 ml/mmHg
Sym 5 mmHg
Cv = 24 x Ca
PRESSURE
(mmHg)

Veins
Sym
Sym
1 2 3 4
VOLUME (L)

• EFFECTS OF COMPLIANCE on Blood Pressure:


Higher Venous Compliance ------> higher capacitance in



veins ------> less venous return ------> lower CVP.


Lower Venous Compliance (sympathetic influence) ------>
lower capacitance veins ------> more venous return via
the one-way valves ------> higher CVP.


Lower Arterial Compliance results in a higher pulse



pressure.


AGE: Arteries in old people have lower compliance. Thus



old people have higher pulse pressures.



EFFECT OF STROKE VOLUME: All other factors
held constant, a high stroke volume results in a
higher pulse pressure, i.e. higher systolic and
lower diastolic but MABP remains constant.


PULSE PRESSURE IS USUALLY DIRECTLY



RELATED TO STROKE VOLUME


EFFECT OF EXERCISE:


Increased CO and Stroke Volume



Compensatory lower vascular resistance (TPR)



MABP doesn't change (within limits).



HIGH SYSTOLIC PRESSURE: Tends to occur



with higher stroke volume.

HIGHER DIASTOLIC PRESSURE:


CORRELATES WITH HIGH TPR.

 Factors affecting ABP:

■

Sex … M > F …due to hormones/ equal at menopause.
■ Age … Elderly > children …due to atherosclerosis.


■ Emotions … due to secretion of adrenaline &



noradrenaline.
■

Exercise … due to  venous return.
■ Hormones … (e.g. Adrenaline, noradrenaline,


thyroid H).
■

Gravity …  Lower limbs > upper limbs.
■ Race … Orientals > Westerns … ? dietry factors, or
weather.
■ Sleep …  due to  venous return.
■ Pregnancy … due to  metabolism.
CHANGES IN CARDIOVASCULAR
PERFORMANCE

BY ALTERING THE CARDIAC FUNCTION CURVE

- CHANGING CONTRACTILITY
- CHANGING HEART RATE

BY ALTERING THE VASCULAR FUNCTION CURVE

- CHANGING MEAN CIRCULATORY PRESSURE
Blood Volume
Venous Capacity
- CHANGING TOTAL PERIPHERAL RESISTANCE
 Regulation of ABP )

cardiac control centers in medulla
oblongata
1. Cardiacaccelerator 2. Cardiacinhibitory
center center
(V.M.C) (C.I.C)

Sympathetic n. fibers Parasympathetic n. fibers

ü Regulatory mechanisms depend on:
a. Fast acting reflexes:
Concerned by controlling CO (SV, HR), & PR.
b. Long-term mechanism:
Concerned mainly by regulating the blood volume.
Vasoconstriction
 Put another way
If your balloon was losing pressure, there are


two actions you can take…



1. put more puff into the balloon (increase CO)


2. let less air out of the balloon by pinching the
end (increase SVR)



A fall in BP triggers vasoconstriction
A fall in BP triggers an increase in cardiac
output
 HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

After-load
PRESSURE

Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 Pressure-Volume Curve


The slope of the curve is compliance.
Pressure is on the X-Axis. Volume is on the Y-


Axis.

If you plot systolic and diastolic pressure, and
look at the corresponding Y-Values, you can
calculate the

following:
The difference on the Y-axis (i.e. the volumes


corresponding to systolic and diastolic

pressures) is stroke volume.
 HEART
SYSTOLIC PRESSURE CURVE

Isotonic (Ejection) Phase

After-load
PRESSURE

Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 E D Y HEART
A S LIT
E TI SYSTOLIC PRESSURE CURVE
C R C
IN TRA
O N
C
Isotonic (Ejection) Phase
After-load
PRESSURE

Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 E D Y HEART
A S LIT
RE TI SYSTOLIC PRESSURE CURVE
C AC
DE TR
O N
C
Isotonic (Ejection) Phase
After-load
PRESSURE

Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 HEART

G D
IN SE SYSTOLIC PRESSURE CURVE
LL A
FI RE
C
IN

Isotonic (Ejection) Phase

After-load
PRESSURE

Isovolumetric
Phase
Stroke
Volume
DIASTOLIC
Pre-load PRESSURE CURVE

End Systolic Volume End Diastolic Volume

 3. Other Vasomotor Reflexes:

 1. Atrial stretch receptor reflex:


 Venous Return  ++ atrial stretch
receptors  reflex vasodilatation &  BP.
 2. Thermoreceptors: (in skin/or
hypothalamus)
• Exposure to heat  vasodilatation.
• Exposure to cold  vasoconstriction.
 3. Pulmonary receptors:

Lung inflation  vasoconstriction.
 Regulation of Blood Volume:

■ A long-term regulatory mechanism.

■ Mainly renal:
 1. Renin-Angiotensin System.
 2. Anti-diuretic hormone (ADH), or
vasopressin.
 3. Low-pressure volume receptors.



 1. Renin-Angiotensin System:

 ■ Most important mechanism for Na+ retention

in
 order to maintain the blood volume.


 ■ Any drop of renal blood flow &/or  Na+, will

 stimulate volume receptors found in
juxtaglomerular
 apparatus of the kidneys to secrete Renin
which will
 act on the Angiotensin System leading to
production
 of aldosterone.
•Renin-Angiotensin System:
 renal blood flow &/or  Na+

++ Juxtaglomerular apparatus of kidneys

(considered volume receptors)

Renin
Angiotensin I
Angiotensinogen
Converting
(Lungs)
enzymes

Angiotensin III Angiotensin II

(powerful vasoconstrictor) (powerful vasoconstrictor)
Adrenal
cortex
Corticosterone
Aldosterone
N.B. Aldosterone is the main regulator of Na+retention.
 2. Anti-diuretic hormone (ADH), or
vasopressin:
 ■ Hypovolemia & dehydration will stimulate
the
 osmoreceptors in the hypothalamus,
which will lead
 to release of ADH from posterior pituitary
gland.


 ■ ADH will cause water reabsorption at

kidney tubules.
 3. Low-pressure volume receptors:

 ■ Atrial natriuritic peptide (ANP) hormone, is

secreted
 from the wall of right atrium to regulate
Na+ excretion
 in order to maintain blood volume.

Substances causing contraction in vascular smooth
muscle

Chemical Physiologic role Source Type

NE (α ) Baroreceptor reflex Sympathetic neurons Neural

Endothelin Paracrine Vascular endothelium Local

Serotonin Platelet aggregation, smooth Neurons, digestive Local, neural

muscle contraction tract, platelets
Substance P Pain, increased capillary Neurons, digestive tract Local, neural
permeability
Vasopressin Increase blood pressure during Posterior pituitary Hormonal
hemorrhage
Angiotensin II Increase blood pressure Plasma hormone Hormonal

Prostacyclin Minimize blood loss from endothelium local

damaged vessels before
coagulation
 Substances that mediate vascular smooth muscle
relaxation
Chemical Physiologic role Source Type
Nitric oxide Paracrine mediator Endothelium Local

Atrial natriuretic Reduce blood pressure Atrial myocardium, Hormonal

peptide brain
Vasoactive intestinal Digestive secretion, relax Neurons Neural, hormonal
peptide smooth muscle
Histamine Increase blood flow Mast cells Local, systemic

Epinephrine (β 2) Enhance local blood flow to Adrenal medulla Hormonal

skeletal muscle, heart, liver
Acetylcholine Erection of clitoris, penis Parasympathetic neural
(muscarinic) neurons
Bradykinin Increase blood flow via nitric Multiple tissues Local
oxide
Adenosine Enhance blood flow to match Hypoxic cells local
metabolism
• TOTAL RESERVE: The total stored
capacity the heart has to do extra
stroke work. It is equal to Starling
Reserve + Inotropic Reserve + Heart-
Rate Reserve.
• STARLING RESERVE: The extent to which
we can increase Cardiac Output simple
by increasing filling, at the same
inotropic state.
• INOTROPIC RESERVE
• HEART-RATE RESERVE
•
• INOTROPIC STATE: It's the contractile
force in the muscle, at any particular
fiber-length. That is the same as the
Ca++ concentration in the
• HEART-RATE AND STROKE VOLUME: Heart
rate extremes lead to lower stroke
volume.
• • Bradycardia: Heart-rate slower than 40,
Cardiac Output goes way down because
the stroke volume can't increase enough
to compensate for the lower heart-rate.
You've reached the maximum of the
heart's inotropic state.
• Tachycardia: Heart-rate faster than 180.
Cardiac Output goes way down because
there is no longer enough time between
beats for sufficient ventricular filling, i.e.
the short diastolic time cuts into the "Fast-
Filling Phase" of diastole.
 MEASURING BLOOD PRESSURE
TURBULENT FLOW

Cuff pressure > systolic blood pressure -- No sound .

The first sound is heard at peak systolic pressure .
Sounds are heard while cuff pressure < blood pressur
Sound disappears when cuff pressure < diastolic pres
Blood Pressure Systolic Diastolic
Category mm Hg (upper #) mm Hg (lower #)

Normal less than 120 and less than 80

Prehypertension 120 – 139 or 80 – 89

High Blood Pressure 140 – 159 or 90 – 99

(Hypertension) Stage 1

High Blood Pressure 160 or higher or 100 or higher

(Hypertension) Stage 2

Hypertensive Crisis Higher than 180 or Higher than 110

(Emergency care needed)

"Understanding blood pressure readings". American Heart Association. 11 January 2011. Retrieved 30 March 2011.