BLOOD

PRESSURE
MECHANISM
SHORT TERM CONTROL OF
BLOOD PRESSURE
Introduction

There are two basic mechanisms for regulating

blood pressure:
(1) short-term mechanisms.
regulate blood vessel diameter, heart rate
and contractility
(2) on!-term mechanisms.
regulate blood volume

Boo" Press#re $ car"iac o#t%#t &

%eri%hera resistance

Any change in cardiac output, blood volume or

peripheral resistance will lead to a change in
blood pressure

!hort term control of "lood pressure is mediated by

the :
I. ner'o#s s(stem
II. Chemicas

that control blood pressure by changing peripheral

resistance ( in sec or minutes)

#apidity of response (beginning within seconds and

often increasing the pressure to 2$ normal (% to 1&
seconds)

!udden inhibition of nervous cardiovascular

stimulation can decrease the arterial pressure (one
half normal)(1&'(& seconds)
I. Ner'o#s S(stem

)ontrol BP by changing blood distribution in the

body and by changing blood vessel diameter

!ympathetic * +arasympathetic activity will a,ects

veins, arteries * heart to control -# and force of
contraction
The vasomotor center

cluster of sympathetic neurons found in the

medulla

It sends e,erent motor .bers that innervate

smooth muscle of blood vessels
S(m%athetic
acti'it(
S(m%athetic
acti'it(
)ASOCONSTRICT
ION

)ASODILATATION
!hort'term #egulation of Risin! Boo"
Press#re
Risin! *oo"
%ress#re
Risin! *oo"
%ress#re
Stretchin! o+
arteria ,as
Stretchin! o+
arteria ,as
Stim#ation o+ *arorece%tors
in caroti" sin#s- aortic arch-
an" other ar!e arteries o+
the nec. an" thora&
Stim#ation o+ *arorece%tors
in caroti" sin#s- aortic arch-
an" other ar!e arteries o+
the nec. an" thora&
Increase" im%#ses to
the *rain
Increase" im%#ses to
the *rain
Barorece%tors

The best /nown of nervous mechanisms

for arterial pressure control (baroreceptor
re0e1)

"aroreceptors are stretch receptors found

in the carotid body, aortic body and the
wall of all large arteries of the nec/ and
thora1

#espond progressively at 2&'13& mm -g

#espond more to a rapidly changing

pressure than stationary pressure
Barorece%tors
E/ect o+ Barorece%tors
"aroreceptors entered the medulla (tractus
solitarius)
!econdary signals inhibit the vasoconstrictor center
of medulla and e1cite the vagal parasympathetic
center
)ASODILATATION
OF THE )EINS AND
ARTERIOLES
Therefore, e1citation of baroreceptors by high pressure in
the arteries re0e1ly causes arterial pressure to decrease
(as decrease in +# and )4)
DECREASED HEART
RATE AND STREN0TH
OF HEART
CONTRACTION
EFFECT
54T6 : )onversely, low pressure has opposite e,ects,re0e1ly causing
the pressure rise bac/ to normal
Increase" Paras(m%athetic
Acti'it(
6,ect of increased parasympathetic
and decreased sympathetic activity
on heart and blood pressure:

Increased activity of vagus

(parasympathetic) nerve

7ecreased activity of sympathetic cardiac

5erves

#eduction of heart rate

8ower cardiac output

8ower blood pressure

Decrease" S(m%athetic Acti'it(
6,ect of decreased sympathetic
activity on arteries and blood
pressure:

7ecreased activity of vasomotor .bers

(sympathetic nerve .bers)

#ela1ation of vascular smooth muscle

Increased arterial diameter

8ower blood pressure

!hort'term #egulation of Fain! Boo" Press#re
Barorece%tors
inhi*ite"
Barorece%tors
inhi*ite"
Decrease" im%#ses to
the *rain
Decrease" im%#ses to
the *rain
Decrease" %aras(m%athetic
acti'it(- increase" s(m%athetic
acti'it(
Decrease" %aras(m%athetic
acti'it(- increase" s(m%athetic
acti'it(
E/ects
Heart
increase" heart
rate an" increase"
contractiit(
)esses
increase"
'asoconstriction
A"rena !an"
release of epinephrine and
norepinephrine which enhance
heart rate
Contractiit( an"
'asoconstriction
Contractiit( an"
'asoconstriction
Increase" *oo" %ress#re
Increase" *oo" %ress#re

S(m%athetic Acti'it( on Heart an"

Boo" Press#re
6,ect of Increased !ympathetic Activity
on -eart and "lood +ressure:
9 Increased activity of sympathetic cardiac
nerves
9 7ecreased activity of vagus
(parasympathetic) nerve
9 Increased heart rate and contractility
9 -igher cardiac output
9 Increased blood pressure
)asomotor Fi*ers
9 6,ect of Increased !ympathetic
Activity on Arteries and "lood
+ressure:
9 Increased activity of vasomotor
.bers (sympathetic nerve .bers)
9 )onstriction of vascular smooth
muscle
9 7ecreased arterial diameter
9 Increased blood pressure
S(m%athetic Acti'it( on A"rena 0an" an" Boo"
Press#re
6,ect of increased sympathetic
activity on adrenal glands and blood
pressure:
9 Increased sympathetic impulses to adrenal
glands
9 #elease of epinephrine and norepinephrine to
bloodstream
9 -ormones increase heart rate, contractility and
vasoconstriction 6,ect is slower'acting and more
prolonged than nervous system control
9 Increased blood pressure
II. Chemorece%tor
Chemorece%tor

)hemosensitive cells that respond to changes in

p)4
2
and p4
2
and p- levels (-ydrogen ion)
%O
1
an"
%H
%CO
1

Stim#ation
o+ 'asomotor
center
CO HR
'asoconstric
tion
BP 2s%ee"in! ret#rn
o+ *oo" to the heart
an" #n!s3
Chemorece%tor
)5! Ischemic #esponse
!evere decrease blood 0ow to brain
)erebral hypo1ia
:asomotor center stimulated ; causes powerful
vasoconstriction
( I5)#6A!6 !<=+AT-6TI) 7I!)-A#>6 ;
5orepinephrine)
Increase blood pressure * blood 0ow
Cushing Reaction
-
!pecial type of )5! Ischemic
#esponse
Increased pressure of cerebrospinal 0uid (cranial
vault)
Increase intracranial tension
)ompress whole brain * arteries in the brain
)uts o, blood supply to brain
)5! Ischemic #esponse initiated * arterial pressure
rises
#elieve brain ischemia
THAN4 5OU66
SHORT TERM
REGULATION OF
BLOOD PRESSURE
Innervation of blood vessels

Sympathetic vasoconstrictor fiber

Distriution! A"#ost a""

seg#ents o$ the
circu"ation%

The inner&ation is
'o(er$u" in the )i*ne+s,
gut, s'"een an* s)in

is "ess 'otent in oth

s)e"eta" an* car*iac #usc"e
an* in the rain%
Innervation of blood vessels

A"#ost a"" &esse"s, such as arteries, arterio"es,

&enu"es an* &eins are inner&ate*%

e-ce't the ca'i""aries, 'reca'i""ar+ s'hincters an*

#ost o$ the #etarterio"es%

Tone! Usua""+ the s+#'athetic &asoconstrictor

$iers )ee' tonic%

Paras+#'athetic ner&e $ier to 'eri'hera"

&esse"s

Paras+#'athetic ner&e $iers inner&ate &esse"s

o$ the "oo* &esse"s in

Meninges

the sa"i&ar+ g"an*s

the "i&er

the &iscera in 'e"&is

the e-terna" genita"s

I#'ortance! Regu"ate the "oo* $"o( o$ these

organs in so#e special situations%
Cardiac Centres (Higher Centres)
-IN ME!""#-
$% Cardio #cceleratory Centre sends sympathetic neurones do&n the spine to
bet&een '$ and '() &here they e*it to the periphery%
+% Cardio Inhibitory Centre originates &ith the ,agus Nucleus in the medulla
and this parasympathetic nerve leaves the cranium as the ,agus (-) Nerve%
.% ,asomotor Centre - is a cluster of sympathetic fibres in the Medulla%
- transmits impulses via sympathetic vasomotor fibres
from '$ to "+ to blood vessels (arterioles)
,asoconstriction is caused by increased fre/uency of impulses (Noradrenaline)
,asodilation is caused by decreased fre/uency of impulses%
0rainstem contains1
2ons
Medulla
In the Medulla are the1
Cardiac #cceleratory Centre
Cardiac Inhibitory Centre
,asomotor Centre
Short.Ter# Regu"ation

Ra%i"( Actin! Press#re Contro Mechanisms-

Actin! 7ithin Secon"s or Min#tes.
A "aroreceptor re0e1es (2& ; 1&& mm-g)
)hange peripheral resistance, heart rate, and
stro/e volume in response to changes in blood
pressure
" )hemoreceptor re0e1es ((& ; 2& mm-g)
!ensory receptors sensitive to o1ygen lac/, carbon
dio1ide e1cess, and low p- levels of blood
) )entral 5ervous !ystem ischemic response (? (&
mm-g)
#esults from severe decrease blood 0ow to the
brain
Barorece'tor re$"e-es
0aroreceptors are found in 1

Carotid Sinuses (blood going to brain) by glossopharyngeal nerve

#ortic #rch (systemic blood going to body) by vagus nerve

#s M#2 increases this stretches the receptors and they send a fast train of
impulses to the ,asomotor Centre% #fter the signals enter the tractus
solitarius) secondary signals inhibit vasoconstrictor centres and e*cite the
vagal parasympathetic center% 'his results in a decrease in the fre/uency
of impulses from the ,asomotor Centre and arterioles dilate% 3inal result
is vasodilation and decreases M#2%
4 CIC activity increases (stimulating the ,agus nerve) - decreases H5 and
S,%
4 C#C activity decreases (inhibiting Sympathetic nerves) - decreases
C6%
Che#orece'tor Re$"e-
)5! Ischemic #esponse
!evere decrease blood 0ow to brain
)erebral hypo1ia
:asomotor center stimulated ; causes powerful
vasoconstriction
( I5)#6A!6 !<=+AT-6TI) 7I!)-A#>6 ;
5orepinephrine)
Increase blood pressure * blood 0ow
Cushing Reaction
-
!pecial type of )5! Ischemic
#esponse
Increased pressure of cerebrospinal 0uid (cranial
vault)
Increase intracranial tension
)ompress whole brain * arteries in the brain
)uts o, blood supply to brain
)5! Ischemic #esponse initiated * arterial pressure
rises
#elieve brain ischemia
THAN4 5OU66
-4#=456! I5:48:6 I5
)A8)I@= =6TA"48I!=
)alcium #egulation

)alcium plays an /ey role in many physiological

process include:
')ontraction of s/eletal, cardiac and smooth
muscle
' "lood clotting and neuromuscular function and
transmission
o
Important feature of e1tracellular calcium
regulation:
'&1 A of total calcium in 6)B
' 1 A in cell
' rest in bone(largest reservoirs)
-
Total )a concentration in blood in blood is
normally at 1&mgCdl
-
(&A bound to plasma protein
-
1&A comple1ed to anion (phosphate, citrate,
sulfate)
-
%&Ais free ioniDed(biologically active)
o
)alcium homeostasis involves E sys
'"one, /idney, >I tract
o
Also involves E hormones
'+T-, )alcitonin, :itamin 7

#elation of )alcium * +hosphate

The calcium and phosphate homeostasis are

lin/ed together

)alcium comple1es with phosphate where more

phosphate present then more calcium bind to it
and reduce the free ioniDed calcium fraction in
6)B

The less phosphate present the less calcium

bind to it and this increase the free, ioniDed
calcium fraction

-ence ,decrease phosphate level in blood help

plasma )a level in blood
+arathyroid -ormone (+T-)

It is secreted when the blood plasma

)a
2F
is decreased

Thus, it prevents hypocalcemia

Also acts to decrease concentration

of phosphate in the plasma

The action is direct in the bone and

/idney

In the intestine, the action is indirect

Action of +T- in bone

Increases bone resorption

)a and phosphate are released to the

6)B

The concentration of )a in the serum

increases
Action of +T- in /idney

+T- promotes )a reabsorption and

inhibits phosphate reabsorption in
the /idney tubules

Inhibition of phosphate reabsorption

causes it to be e1creted in the urine,
a condition named phosphaturia

!ince )a is reabsorbed, its

concentration in the plasma is
elevated
Action of +T- on intestine

+T- has no direct e,ect on the

intestine

It indirectly increases )a and

phosphate absorption to the small
intestine by activating vitamin 7

:itamin 7 will promote )a upta/e by

the intestine
Action of :itamin 7

The active form of vitamin 7,12%'

dihydro1ycholecalciferol has several
e,ect on

Intestine

Gidney

"one

>eneral function of vitamin 7 is increase

absorption of calcium and phosphate
into the 6)B
6,ect on intestine

1,2%'7ihydro1ycholecalciferol promote
absorption of calcium by formation of a
calcium- binding protein in the intestinal
epithelial cells

The functions of protein are transport the

calcium into the cytoplasm, then the calcium
move to basolateral membrane by difussion

The rate of calcium absorption is directly

proportional to the Huantity of this calcium-
binding protein

4ther e,ect of 1,2%

dihydro1ycholecalciferol :
The formation of :'
1 a calcium stimulated AT+ase in the
brush border of the epithelial cells
2 an al/aline phosphatase in the
epithelial cells
6,ect on Intestine

:itamin 7 also promote phosphate

absorption

@sually phosphate absorb easily, phosphate

0u1 through the gastrointestinal epithelium
is enhance by vitamin 7

It is a direct e,ect of 1,2%'

dihydro1ycholecalciferol

Action on calcium absorption : the calcium

in'turn acting as a transport mediator for
the phosphate
6,ect on renal (/idney)

:itamin 7 also decrease renal

calcium and phosphate e1cretion

Also increases calcium and

phosphate absorption by the
epithelial cells of the renal tubules,
thereby tending to decrease
e1cretion of this substances in the
urine
E/ect on *one an" it reation to
%arath(roi" hormone acti'it(

:itamin 7 play important role in both bone

absorption and deposition

61treme Huantities of vitamin 7 causes

absorption of bone

Absences of vitamin 7, the e,ect of +T- in

causing bone absorption is greatly reduce
or even prevented

:itamin 7 in small Huantities promote bone

calci.cation which is vit 7 increase calcium
and phosphate absorption from intestine
E/ect on *one an" it reation to
%arath(roi" hormone acti'it(

:itamin 7 play important role in both bone

absorption and deposition

61treme Huantities of vitamin 7 causes

absorption of bone

Absences of vitamin 7, the e,ect of +T- in

causing bone absorption is greatly reduce
or even prevented

:itamin 7 in small Huantities promote bone

calci.cation which is vit 7 increase calcium
and phosphate absorption from intestine
calcitonin
biosynthesis

)alcitonin is formed by
theproteolyticcleavage of a
largerprepropeptide, which is the product
of the )A8)1 gene (CALCA) The )A8)1
gene belongs to a superfamily of related
protein hormone precursors includingislet
amyloid precursor protein,calcitonin
gene'related peptide, and the precursor
ofadrenomedullin
physiology
The hormone participates incalcium()a
2F
) andphosphorus
metabolism In many ways, calcitonin counteractsparathyroid
hormone(+T-)
'To be speci.c, calcitonin a,ects blood )a
2F
levels in four ways:
'Inhibits )a
2F
absorption by theintestines
'Inhibitsosteoclast activity inbones
'Inhibits phosphate reabsorption by the/idneytubules

Increases absolute )a
2F
and =g
2F
reabsorption by
the/idneytubules, calcitonin is a renal )a'conserving
hormone

!ecretion of calcitonin is stimulated by:

'an increase in serum J)a
2F
K
''gastrinandpentagastrin
actions

this actions, in a broad sense, are:

"one mineral metabolism:

' +rotect against )a

2F
loss from s/eleton during
periods of )a
2F
stress such
aspregnancyandlactation

!erum calcium level regulation

' +revent postprandialhypercalcemiaresulting from

absorption of )a
2F
from foods during a meal':itamin
7regulationAsatietyhormone:

' Inhibit food inta/e in rats and mon/eys' =ay

have)5!action involving the regulation of feeding
and appetite
receptor

Thecalcitonin receptor, found

primarily on osteoclasts, is a>
protein'coupled receptor, which is
coupled by>
s
toadenylyl
cyclaseand thereby to the
generation ofcA=+in target cells It
also a,ect the ovaries in women and
the testes in men
T-A5G <4@
686)T#4)A#7I4>#A=
5ormal 6)> and 8eads
Lhat is 6)>M

Transthoracic interpretation of
theelectricalactivity of
theheartovertimecaptured and
e1ternally recorded by s/in
electrodes

The sum of the electrical activity

generated by the heart
-ow do 6)> wor/sM

It wor/s by detecting and amplifying

the tiny electrical changes on the
s/in that are caused when the heart
muscle NdepolarisesN during each
heart beat

6)> is measured by placing s/in

electrodes on the body surface at
di,erent locations

This eectro"es are connected in

di,erent con.guration to a ampli.er
and a recorder
5ormal 6)> )haracterM
The 6)> comprise of several waves:

+ wave

O#! comple1

T wave
Lhat is + waveM

)aused by the electrical potentials

generated when the atria depolarise
before the contractions begins

This is depolariDation wave

Lhat is O#! comple1M

It is caused by potentials generated

when the ventricles depolariDed
before contraction

This is depolariDation wave

Lhat is T waveM

It is caused by potential generated as

the ventricles recover from the state
of depolariDation

It is /nown as repolariDation wave

Lhat is 6)> 8eadsM

They are electrical cable attaching

theelectrodesto the 6)> recorder

They also may refer to the tracing of

thevoltagedi,erence between two
of the electrodes and is what is
actually produced by the 6)>
recorder
-ow many leads are thereM
There are 12 leads:

E limbs lead (I, II, III)

E Augmented leads (a:#, a:8, a:B)

2 +recordial 8eads (:
1
; :
2
)
8imbs lead
+recordial 8eads
Augmented 8eads
T-A5G <4@