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Blood pressure regulation

Talking about CVS means that you have to talk about an important issue which is Regulation of Blood Pressure Previously weve discussed the systolic and diastolic blood pressure; #systolic blood pressure: refers to ventricular contraction #diastolic blood pressure: refers to recoil of the aorta # mean blood pressure: its the average blood pressure at a specific moment; formula: mean blood pressure =diastolic+(Systolic-diastolic)/3 Hypertension: it is the sustained elevation of blood pressure

beyond the normal average.


Now what is the relationship between Blood Pressure & blood flow?? Blood pressure: it is the force exerted by blood on a unit area of a blood vessel. Once there is an increase in the blood flow that will lead to an increase in blood pressure and the blood flow is increased by an increase in the hearts output rate which is related to the volume of blood pumped by

each ventricle per minute (not the total amount of blood pumped by the heart)from Sherwood
Cardiac output = stroke volume * heart rate

Cardiac Output (CO) is the amount of blood pumped by each ventricle in one minute CO is the product of heart rate (HR) and stroke volume (SV) CO = HR x SV

(ml/min) = (beats/min) x ml/beat HR is the number of heart beats per minute SV is the amount of blood pumped out by a ventricle with each beat Cardiac reserve is the difference between resting and maximal CO

Once there is an increase in the stroke volume and heart rate, the

cardiac output will be increased thereby increasing the blood flow as


well.

Blood Pressure
#hypertension: increase in blood pressure. #hypotension: decrease in blood pressure. The fear of hypertension is due to the complications it may cause. We dont care about hypotension which is within normal average especially in ladies, they have hypotension (100/60) but it still acceptable. However (80/30) is not acceptable.

Blood Pressure regulation


Blood pressure regulation is important and there are two mechanisms for controlling it, we have short term regulation (moment to moment regulation) and long term regulation. 1-Short term regulation: it means the regulation of blood pressure within seconds, that is, things that will affect the blood pressure in a short period of time like,

changing of the posture (position) of the human being, like sitting or


standing or lying down. So it is the moment to moment regulation of blood pressure which is the mechanism which takes care of the situation/position of the body. However, long term regulation of blood pressure is over minutes and above. With short term regulation we talk about Baroreceptors. Principle: in the arch of aorta and the carotid artery we have baroreceptors which are a collection of neurons which are sensitive

to either decrease or increase in blood pressure. It is closely


related to ohms law in blood pressure, which reflects on the cardiac

output.
So what happens when there is an increase in blood pressure? First station: These baroreceptors will be stretched and they will send a signal to the vasomotor center which is located in the medulla

oblongata, where we have tractus solitarias which is a collection of


nuclei in which we have vasoconstrictor and vasodilator areas. Second station: it is the vasomotor centers which is located in the medulla oblongata, which is called tractus solitarias.

Hypotension:
In case of hypertension, increase in blood pressure, these tractus solitarias areas will stimulate the sympathetic nerves. Anatomically theyre situated between T1 and L2 and they are called the paravertebral ganglion. So, signals on the vasomotor center will travel to the sympathetic nerves then to the heart leading to an increase in the heart rate and its contractility. The sympathetic innervations are involved in increasing the heart rate and its contractility. Why? Because sympathetic innervations innervate mainly the ventricles as the bulk of the cardiac output is created from the left ventricle. So, the cardiac output will be increased due to the increase in the contractility and heart rate and as the cardiac output increases that means the blood flow will increase and increase in blood pressure.
In summary: 1-taractus solitarias stimulates -> sympathetic nerves(paravertebral ganglion) 2-signals from sympathetic nerves travel to -> the heart increasing its rate and contractility 3-cardiac output increases 4-blood flow increases 5-blood pressure increases 6-hypertension

Hypotension:
In case of hypotension, the same Signals will be sent from the baroreceptors to the vasomotor center but the main difference is that the sympathetic innervations will be blocked rather than stimulated. So the contractility will be decreased and heart rate will be decreased

and cardiac output will be decreased thereby decreasing the blood pressure leading to hypotension.

2-Long term regulation: it means the regulation of blood pressure within minutes or more. When somebody undergoes hemorrhage ( bleeding) they will enter in a state of hypovolemic shock this means a decrease in blood pressure because the filling pressure(venous return) to the heart will be decreased and in the end the cardiac output will be decreased so well end up with hypotension which cannot be corrected by baroreceptors. So what exactly will happen? Now when there is hypotension it will affect all the organs in the body and in the state of a hypovolemic shock there will be an extensive stimulation of the sympathetic innervations all over the body but mainly in the kidneys and blood vessels. In the Kidneys, there will be a decrease in blood flow. As a result Renin will be secreted from the kidneys (due to low blood flow). Renin will convert angiotensinogen, which is secreted from the liver, to angiotensin l (an alpha globulin) which is inactive. Angiotensin l will be converted to angiotensin by angiotensin converting enzyme (ACE) in the lungs.

Renin is a protease which cleaves


angiotensinogen to angiotensin I

Angiotensin is very important and has the following effects: 1- It is one of the most potent vasoconstrictors in the body.

Renin is secreted by the juxtaglomerular apparatus in response to: 1: reflexive sympathetic activity or beta receptor stimulation 2: decreased central volume of blood 3: decreased plasma Na+ 4: decreased distension of renal arteries

2- It enhances the secretion of aldosterone from the cortex of the adrenal gland. (Aldosterone will cause sodium and water retention=hypertension). 3- It stimulates the reabsorption of sodium and water from the proximal tubules of the kidney. 4- It blocks bradykinin which is a vasodilator.

Heart Failure

NOTE

Heart failure is the inability of the cardiac output to keep


pace with the bodys demand for supplies and removal of wastes. Either one or both ventricles may progressively weaken or fail. When a failing ventricle cannot pump out all the blood returned to it, the veins behind the failing ventricle become congested with blood. Heart failure may occur for a variety of reasons but the two most common are (1) Damage to the heart muscle as a result of a heart attack or impaired circulation to the cardiac muscle (2) Prolonged pumping against a chronically elevated blood pressure.
SHERWOOD

COMPENSATED ACUTE #Heart failure: CHRONIC DECOMPENSATED

As illustrated in the above diagram, heart failure is divided into acute and chronic and the acute heart failure is further divided into compensated and decompensated acute heart failure. Compensated heart failure is the one in which rennin, angiotensin and the aldosterone system are capable of maintaining normal blood pressure, and it can be regulated by long term regulation.

Aldosterone:
A Steroid hormone secreted by the adrenal medulla in response to angiotensin II formation Increases blood volume by promoting reabsorption of sodium Takes hours to be effective in raising blood pressure and volume because it requires protein synthesis

NOTE:

As you go towards high altitudes blood pressure will increase

due to hypoxia, also as you go towards low altitudes there will be

increase in blood pressure but the concentration of angiotensin remain the same in low and high altitudes.

will

Thats why most of hypotensive drugs are working on the ACE, they are ACE inhibitors, they blocks the conversion of angiotensin I to angiotensin .

A Student asked: why do we use these ACE inhibitors?? Answer: Inhibitors are used for patients with hypertension, otherwise, how will I inhibit the increase in blood pressure?! Thats why I have to block the conversion of angiotensin I to angiotensin II thus all the effects of angiotensin II will be blocked.

So, in general what causes the increase in blood pressure? It is the concentration of salts, water..etc

Therefore blocking angiotensin II will inhibit the retention of sodium and water so that well prevent the increase of Blood pressure and also preventing the reabsorption of water and salts from renal tubules and thats the principle of the action of most of the hypertensive drugs.

Hormones effecting blood pressure


In the first lecture we said that the brain and endocrine system are the systems of coordination. Now we have the suprarenal gland, the medulla of this gland secretes adrenaline and noradrenaline. They have their role in the control of blood pressure because adrenaline and nor adrenaline cause peripheral
Q: Why veins are innervated by sympathetic innervations?
It relates to the function of the veins which is being reservoirs of blood, so in case of sympathetic stimulation as in when we are in the need of more blood well get blood from here.

vasoconstriction and central vasodilatation. (Central means the heart)

Anti-puritic hormones also participate in maintaining the blood pressure, they are also known as vasoconseen. It is the most potent vasoconstrictor in the body, secreted from the hypothalamus it

enhances the reabsorption of water from the collecting tubules of the


kidney and causes vasoconstriction thats why it helps in maintaining a normal blood pressure. Another mechanism for controlling blood pressure is the atrial

natriuretic hormone/peptide (ANP) which enhances the secretion of sodium and water from the kidneys.
In addition we have a center in the brain called the Central nervous system ischemic reflex, which affects the vasomotor center in medulla oblongata, which is sensitive to the decrease in blood pressure.

Here are some useful diagrams for the lecture: 1-The Role of the Renin-Angiotensin System in Regulating Arterial Pressure

For more details go back to Sherwood or Guyton including the slides .. they are useful..
Hope that you enjoyed the lecture, Sorry for being late, forgive me if there is any mistakes

With my 1 Heart...2 eyes...5 liters blood...206 bones...1.2million Red Cells... 60 trillion D.N.A.'s... I wish u "All the very best of luck"..

Done by:

Sawsan Jwaied