BLOOD PRESSURE

1. Integrate ideas from the heart and the circulatory system to

describe the determinants of mean arterial pressure
- Mean arterial pressure is the main driving force for propelling blood to
the tissues
- It must be closely regulated so that it is high enough to ensure
sufficient driving pressure. Also the pressure must not be too high that
it creates extra work for the heart and increases the risk of vascular
damage
- The primary determinants for mean arterial pressure are cardiac
output and total peripheral resistance

The mean arterial pressure is constantly monitored by baroreceptors

(pressure sensors) within the circulatory system. When deviations are
detected, multiple reflex responses are initiated to return meal arterial
pressure to its normal value.
Short term: (occur within seconds)
1) Adjustments made by alterations in cardiac output and total
peripheral
resistance. It is mediated by means of
autonomic nervous system influences on heart, veins, and
arterioles

Long term: (require minutes to days)

1) Involve adjusting total volume blood by restoring normal salt
and water balance through mechanism that regulate urine output and
thirst
2. Describe how mean arterial pressure is sensed and identify
the reflex response that would occur when stimulating these
pressure sensors
- Any change in meal arterial pressure triggers an automatic
baroreceptor reflex.
- The most important receptors involved in the moment-to-moment
regulation of blood pressure, the carotid sinus and aortic arch
baroreceptors, are mechanoreceptors sensitive to changes in both
mean arterial pressure and pulse pressure.
* Fluctuations in pulse pressure enhance their sensitivity as
pressure sensors because changes in diastolic or systolic pressure may
alter the pulse pressure without changing the mean pressure
* Located about the common carotid arteries and in the major
arterial trunk
- When arterial pressure increases, the receptor potential of the
baroreceptors increases, this increasing the rate of firing in the
corresponding afferent neurons. And vice versa.
- The integrating center that receives the afferent impulses is the
cardiovascular control center, located in the medulla within the
brain stem.
- The efferent pathway is the autonomic system. The cardiovascular
control center alters the ratio between sympathetic and
parasympathetic activity to the effector organs (heart and blood
vessels)

There are other reflexes and responses that influence the

cardiovascular system even through they primarily regulate other body
functions
1. Left atrial volume receptors and hypothalamic osmoreceptors are
important in water and salt balance in the body; they affect long-term
regulation by controlling plasma volume
2. Chemoreceptors located in the carotid and aortic arteries are
sensitive to low O2 or high acid levels in blood. Their main function is
to increase respiratory activity but also increase blood pressure but
sending excitatory impulses to the cardiovascular center.
3. Differentiate between primary and secondary hypertension
Hypertension is when the blood pressure is too high. (Above 140/90
mmHg)

Secondary Hypertension:
- Accounts for about 10% of hypertension cases
- Occurs secondary to another known primary problem
- Ex) Renal hypertension, Endocrine hypertension. Neurogenic
hypertension
Primary Hypertension:
- Is a catch-all category for blood pressure elevated by a variety of
unknown causes rather than by a single disease entity
- People show a strong genetic tendency to develop primary
hypertension, which can be hastened by contributing factors
such as obesity or smoking
- Potential causes
o Defects in salt management by the kidneys
o Excessive salt intake
o Diets low in fruits, vegetables, and dairy products
o Plasma membrane abnormalities, such as defective Na+K+ pumps
o Variation in the gene that encodes for angiotensinogen
o Abnormalities in NO, endothelin, or other locally acting
vasoactive chemicals
o Excess vasopressin
* the baroreceptors do not respond to bring the blood pressure back to
normal during hypertension because they reset to operate at a
higher level.
Complications
- Congestive heart failure
- Stroke
- Heart attack
- Spontaneous haemorrhage
- Renal failure
- Retinal damage
Treatment
- Dietary management
- A variety of drugs that manipulate salt and water management
- Autonomic activity on the cardiovascular system
* Agents that reduce plasma volume or total peripheral resistance will
decrease blood pressure toward normal
4. Integrate the heart and circulatory sections to determine
how the body would compensate in response to a decrease in
blood volume (shock)

Hypotension is when the blood pressure is below 100/60 mmHg. It

occurs when there is too little blood to fill the vessel of when the heart
is too weak to drive the blood.
The most common situation where hypotension occurs is orthostatic
hypotension. Orthostatic hypotension is a condition resulting from
insufficient compensatory responses to gravitational shifts in blood
when a person moves from horizontal to vertical position.
Circulatory shock occurs when blood pressure falls so low that
adequate blood flow to the tissues can no longer be maintained.
Circulatory shock is categorized into four main types
1) Hypovolemic (low volume) shock occurs through severe
haemorrhage or indirectly though loss of fluids derived from the
plasma (diarrhoea, sweating)
2) Cardiogenic (heart produced) shock sue to a weakened hearts
failure to pump blood adequately
3) Vasogenic (vessel produced) shock caused by widespread
vasodilation triggered by the presence of vasodilator substances. There
are two types of Vasogenic shock: septic and anaphylactic. Septic
shock is due to vasodilator substances released from infective ages.
Similarly, extensive histamine release in severe allergic reactions can
cause widespread vasodilation in anaphylactic shock.
4) Neurogenic (nerve produced) shock involves generalized
vasodilation but not by means of the release od vasodilator
substances. Loss of sympathetic vascular