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    9- Arterial Blood Pressure (Bp)

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    9- Arterial Blood Pressure (Bp)

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    9- Arterial Blood Pressure (Bp)

    Uploaded by

    doleephassan

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 29

    ARTERIAL BLOOD

    PRESSURE (BP)

    Dr. Abdalla Adam Abdalla


    OUTLINE

     Definition of blood pressure (BP).


     Systolic pressure.
     Diastolic pressure.
     Pulse pressure.
     Mean arterial blood pressure.

     Physiological variations.
     Factors determine normal pressure:
    1. Cardiac output (co).
    2. Peripheral resistance (PR).
    3. Blood volume..
    ARTERIAL BLOOD PRESSURE (BP)

     Pressure generated by the pumping action of the heart on the


    wall blood vessels / unit area.
     OR = Pressure inside aorta & big arteries.
     Measured in (mmHg) or (cmH2O) [1 mmHg = 1.36 cmH2O].
     Systolic Pressure
     Created when the ventricles contract.
     Around 120 mm Hg.
     Diastolic Pressure
     Created by the recoil of the aorta.

     Around 80 mm Hg.
     Normal values??
     systolic = 110-140 mmHg.
     diastolic = 70-90 mmHg.
     According to (WHO), normal = 140/90 or less..
    The upper limits of normal ABP in different age groups

    Age (years) Upper limits of normal ABP


    (mmHg)

    20 – 10 90 /140
    50 – 20 95 /150
    Over 50 100 /160

    Any levels higher than these limits are considered as hypertension


    – Pulse Pressure
    • Systolic - diastolic pressure.
    – Usually 40 mm Hg (120 mm Hg – 80 mm Hg).
     Only applies to arteries.
    – Mean Arterial Pressure (MAP).

    MAP = diastolic + 1/3 (Pulse Pressure).


    MAP = 80 mm Hg + 1/3( 120 – 80).
    MAP = 93 mm Hg.
    Factors produce normal variation
    ■ Sex: M > F due to hormones/equal at menopause.
    ■ Age: Elderly > children …due to atherosclerosis.
    ■ Emotions:  due to adrenaline & noradrenaline.
    ■ Exercise:  due to  venous return.
    ■ Hormones:  (e.g. Catecholamines, thyroid H).
    ■ Gravity: Lower limbs > upper limbs.
    ■ Race: Orientals > Westerns …? Dietary/weather.
    ■ Sleep:  due to  venous return ( HR & SV).
    ■ Pregnancy:  due to  metabolism.
    ■ Body built: Obese have  BP and..
    Measuring Blood Pressure
    1. Direct (experimental)
    2. Indirect
    A. Auscultation method:
    Measured using
    I. Sphygmomanometer.
    II. Stethoscope.
    B. Palpation method:
    Using sphygmomanometer..
    Mechanism of measuring Blood Pressure
    1. Wrap the cuff around brachium.

    2. Place stethoscope at bifurcation of brachial artery.


    3. Inflate by pump (valve closed).
    4. Deflate slowly (valve opened).
    5. Sound beginning (korotkov sound) = systolic pressure.
    6. Sound disappear = diastolic pressure..
    Precautions of measuring BP
    1. Level of apparatus.

    2. Relaxation of Pt.
    3. Normal variation & physiological conditions.
    4. Cigar.. and caffeine (tea, coffee, …).

    5. Medication.

    6. Duration of measuring.

    7. Obesity.

    8. Frist time measure two sides..


    Factors determining ABP:
     Blood Pressure = COP X P. Resistance

     Maintaining B.P. is important to ensure a steady


    blood flow (perfusion) to tissues.
     BP depends on:
    1. Cardiac output.
    2. Peripheral resistance.
    3. Blood volume..
    CONTROL OF BLOOD PRESSURE
    1. LOCAL REGULATION (Intrinsic).
    o Myogenic response. Control Peripheral
    o Paracrine Resistance

    2. SYSTEMIC REGULATION (Extrinsic).


    A. Short term control (Neural reflex):
     Control COP and Peripheral Resistance by:
    o Baroreceptor reflex
    B. Long-term control (Hormonal regulation):
     Regulate blood volume by:
    o Renin/ angiotensin/ aldosterone system
    o Vasopressin
    o Atrial natriuretic peptide…
    1. LOCAL REGULATION (Intrinsic)
    A. Myogenic response: by smooth muscle of arterioles
    – Increased stretch due to increasing blood pressure causes vessel
    constriction due to mechanically gated Ca2+ channel activation
    B. Paracrine: local substances which alter smooth muscle activity.
    – Serotonin
    vasoconstrictors » Secreted by activated platelets
    – Endothelin
    » secreted by vascular endothelium

    – NO secreted by vascular endothelium


    – Bradykinin – from various sources
    vasodilators – Histamine – from mast cells in connective tissues
    – Adenosine secreted by cells in low O2 (hypoxic) conditions
    – O2, CO2, K+, H+, temp
    Other Hormones and
    Neurotransmitters
    Vasoconstrictors:
     NE – sympathetic postganglionic neurons.
     Serotonin – neurons.
     Vasopressin (ADH) – posterior pituitary.
     Angiotensin II – part of renin-angiotensin pathway
     Vasodilators:
     Beta-2 epinephrine – from adrenal medulla.
     Ach – parasympathetic postganglionic neurons.
     ANP & (BNP) – from atrial and ventricular myocardium.
     VIPs (vasoactive intestinal peptides) – from neurons…
    2. SYSTEMIC (EXTRINSIC)
    REGULATION
    CONTROL OF BLOOD PRESSURE
    1. LOCAL REGULATION (Intrinsic).
    A. Myogenic response.
    Control PR
    B. Paracrine

    2. SYSTEMIC REGULATION (Extrinsic).


    A. Short term control (Neural reflex):
     Control COP and PR by:
    o Baroreceptor reflex
    B. Long-term control (Hormonal regulation):
     Regulate blood volume by:
    – Renin/ angiotensin/ aldosterone system
    – Vasopressin
    – Atrial natriuretic peptide..
    1. Aortic & carotid baroreceptors
    Mediated by cardiac centers in medulla oblongata

    1. Cardiac-accelerator center 2. Cardiac-inhibitory center


    (V.M.C) (C.I.C)

    Sympathetic fibers Parasympathetic fibers


    Vasoconstrictor fiber
     Distribution: skin> viscera > brain and coronary artery.
     Most vessels only controlled by vasoconstrictor fibers.
     NA,  receptor  vasoconstriction..

    Vasodilator fiber
     Sympathetic vasodilator fiber:
     Arterioles in skeletal muscle and….
     ACh, M receptor.
     Parasympathetic vasodilator fiber:
     Vascular smooth muscle in saliva gland, exocrine gland in GI tract,
    ….
     ACh, M receptor.
    Effects of AD and NA on heart and blood vessel

    Adrenaline Noradrenaline

    Heart 1 receptor  CO  1 receptor  CO

    Vessels  In low concentration  dilation of vasoconstriction in all


    resistance vessels (β2) vascular beds (α1)
     higher concentrations 
    vasoconstriction (α1)
     in the skin  only vasoconstriction

    Effect CO and PR no changes CO  and PR , BP 

    Clinical Cardiotonic Vasoconstrictor


    use
    Overview of short-term control mechanisms

    From: Introduction to Cardiovascular physiology. J.R. Levick. Arnold 4th edition (2003)
    CONTROL OF BLOOD PRESSURE
    1. LOCAL REGULATION (Intrinsic).
    A. Myogenic response.
    Control PR
    B. Paracrine

    2. SYSTEMIC REGULATION (Extrinsic).


    A. Short term control (Neural reflex):
     Control COP and PR by:
    o Baroreceptor reflex
    B. Long-term control (Hormonal regulation):
     Regulate blood volume by:
    – Renin/ angiotensin/ aldosterone system
    – Vasopressin
    – Atrial natriuretic peptide..
    Long term control of blood pressure
     Control sodium & blood volume.
     It is hormonal:
    1. Renin-angiotensin-aldosterone system.
    2. Vasopressin (Antidiuretic hormone [ADH]).
    3. Atrial natriuretic peptide (ANP).
    Renin-Angiotensin System
     renal blood flow &/or  Na+

    ++ Juxtaglomerular apparatus of kidneys


    (considered volume receptors)

    Renin
    Angiotensinog Angiotensi
    en nI
    Converting
    (Lungs)
    enzymes
    Angiotensin III Angiotensin II
    (powerful (powerful
    vasoconstrictor) vasoconstrictor)
    Adrenal
    cortex
    Aldosteron Corticostero
    e ne
    Renin/angiotensin feedback system
    Reduced
    renal
    blood flow
    Increased
    Juxtaglomerula blood
    r volume
    apparatus LV filling pressure)
    Increase
    Reni Fluid re- d
    n absorption pre-load
    Angiotensinoge Sodium
    (LV pressure
    beginning of systole)
    n retention Increased
    after-
    Angiotensin
    load
    I Increased
    Angiotensin aldosterone
    II secretion
    Veins
    vasoconstrictio
    n Arterie
    s
    HYPERTENSION
     BP >150/95 (in adults 20-50 yrs) on repeated estimation.
     Types:
    1- Primary (essential) hypertension:
    o Result of vasoconstriction.
    o Unknown cause.
    o Influence of weight gain and sedentary lifestyle.

    2- Secondary hypertension:
    o This occurs as a result of another disease.
    (e.g. adrenal gland tumor   cortisol, Aldosterone & adrenaline).

    3- Malignant hypertension:
    o Severe type characterized by marked elevation of
    ABP without obvious causes.
    o Life threatening.
    Health
    needs
    hard
    work

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