Mechanisms of Hypertension

Arterial Pressure
Determined by:
a. Cardiac Output (Stroke Volume x Heart Rate)
b. Periphearal Resistance
Stroke Volume
- Related to myocardial contractility and to the size of vascular compartment.
Peripheral resistance
- Determined by functional and anatomical changes in small arteries (Lumen
diameter 100-400 um) and arterioles.
1. Intravascular Volume
o Primary determinant of arterial pressure over long term
Sodium
- Predominantly an extracellular ion
- Primary determinant of extracellular fluid volume
NaCl intake exceeds the capacity of the kidneys to excrete Na

Vascualr volume initially expands

Cardiac output Increases

*Blood Flow = ressure across the vascular bed/vascular resistance
Initial elevation of blood pressure in response to vascular volume expansion

Increased cardiac output

Peripheral resistance increases

Cardiac Output reverts toward normal

Cardiac
Output
Arterial
Pressure

Periphera
l
Resistanc
e

Stroke
Volume
Heart
Rate
Vascualr
Structure
Vascular
Function

Figure 1 Determinants of Arterial Pressure

The Effect of Na on blood pressure is related to the provision of Na with Cl.

Increase NaCl Intake

Increase Arterial Pressure

Increase Urinary Sodium Excretion

Sodium Balance
Pressure-Natriuresis Phenomenon
- Increase in glumerular filtration rate
- Decreased absorbing capacity of the renal tubules
- Hormonal factors such as atrial natriuretic factors
Note: Impaired capacity to excrete sodium, greater increases in arterial pressure are
required to achieve natriuresis and sodium balance.
NaCl-dependent Hypertension
- Consequence of either:
a. Intrinsic renal disease
b. Increased production of a salt-retaining hormone (mineralocorticoid)

Increase renal tubular reabsorption of Na

May augment in increased neural activity to the kidneys

Increase arterial pressure may be required to

achieve Na balance

Salt-wasting Disorders

Associated with low bp levels

ESRD
- Associated with volume-dependent hypertension
Note: ~80% vascular volume and hypertension can be controlled with dialysis
Note: ~20% RAAS; and pharmacologic blockade of Renin-Angiotensin
2. Autonomic Nervous System
o Maintains cardiovascular homeostasis via:
a. Pressure
b. Volume
c. Chemoreceptor signals
Long-term Regulation of Arterial Pressure
*Adrenergic Reflex modulate blood pressure over the short-tem
a. Adrenergic Function
b. Hormonal Factors
c. Volume-related Factors
Endogenous Catecholamines that play important roles in the tonic and phasic
cardiovascular regulators:
a. Epinephrine
b. Norepinephrine
c. Dopamine