BLOOD PRESSURE

DR NILESH KATE
MBBS,MD.
 OBJECTIVES
At the end of this class, you should able to recollect.
 Definition of Blood Pressure Its variations.
 Measurement - Korotkoff sound
 Factors contributing to B.P
 Peripheral resistance
 Regulation of BP
 Immediate regulation
 Short term regulation
 Long term regulation.
 Applied - Hypertension - Hypotension
 Physiology of treatment.
 ARTERIAL BLOOD PRESSURE
Definition : Arterial blood pressure can be
defined as the lateral pressure exerted
by the moving column of blood on the
walls of the arteries.
Tuesday, February 16, 2016
 SIGNIFICANCE
1. To ensure the blood flow
To various organs.

2. Plays an important role

in exchange of nutrients
and gases across the
capillaries.

3. Required to form urine.

4. Required for the formation

Of the lymph.
 Normal Values

 Normal Adult range

 Can fluctuate within a
wide range and still
be normal
 Systolic/diastolic
 100/60 - 140/80
 Systolic B.P (S.B.P)
Defined as the maximum
B.P in the arteries
Attainable during systole.
Normal 120 + 20 mm Hg.
This is mainly contributed by

1. Force of heart beat

2. Normal blood volume

3. Cardiac output.
Normal range
90-140 mm Hg.
 DIASTOLIC B.P (D.B.P)

Def--- as the minimum

pressure that is obtained at the
end of the ventricular diastole.
Normal range 60 -90 mm Hg.
1. It represents a constant load
on the arterial walls with
little or no fluctuation at all.
2. It is an index to the
peripheral resistance and
decides the filling of the
Coronary system.

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 Pulse Pressure (P.P)

Denotes the difference

between
systolic and diastolic
pressure.
PP= SBP - DBP = 40
mm Hg
 MEAN ARTERIAL PRESSURE
Mean arterial .BP = DBP +
1/3 Pulse Pressure

normal = 95 mm Hg.

•Not the arithmetical mean but geometrical

mean.
•It is because the period of the systole is only
0.3 sec when compared to 0.5 sec of the
diastole.
ARTERIAL BLOOD PRESSURE
 PHYSIOLOGICAL VARIATION IN BLOOD
PRESSURE
A) Age G) Gestation
B) Build H) high Altitude
C) Climate I) Infusion/ Intake
D) Diurnal Variation J) Pain
E) Exercise K) Posture
F) Fever L) Sleep
M) sex
 RECORDING OF B.P
Direct method

Indirect method

METHODS
Indirect Methods

1. Palpatory method
2. Auscultatory
method

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PRINCIPLE INVOLVED IN RECORDING BLOOD
PRESSURE

Slide
 Measurement Device

Aneroid Simple mercury

sphygmomanometer sphygmomanometer

Automated bp device
 RECOMMENDED BLOOD PRESSURE
MEASUREMENT TECHNIQUE
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3
AUSCULTATORY METHOD
This method was introduced by a Russian physician
Korotkov
SBP
120 mm Hg Tapping sound 1
Recording of
arterial BP by
auscultatory 110 mm Hg Murmurish 2
method
Korotkov 95 mm Hg Banging sound 3
sounds
Muffing sound 4
85 mm Hg

DBP- 80 mm Hg No sound 5
CTORS MAINTAINING
OOD PRESSURE

1. Cardiac output (CO= SV X PR)

2. Circulating blood volume
(This mainly affects systolic B.P)
3. Elasticity of the vessel wall
4. Viscosity of blood
 Viscosity is affected by
1. Cell count
2. Plasma proteins
3. Chemical composition like
CO2, O2 content,PH.
4. Temperature
5. Drugs like general anaesthetics.

All these factors influence

peripheral resistance through viscosity
Peripheral Vascular Resistance

It is defined as the resistance

offered to the flow of blood
by the blood vessels.

It is contributed by:
The Smooth muscles of the
arterioles in particular.

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FACTORS AFFECTING BLOOD PRESSURE
 Disease  Environmental
 Age factors
 Heredity  Psychological factors

 Blood Volume  Stress/Anxiety

 Weight  Gravity

 Diet  Drugs

 Hormones  Alcohol

 Salt  Time of day

 Caffeine
 BLOOD PRESSURE
BP = Cardiac output X PR
Peripheral resistance(PR) in a normal healthy young
adult is 20mm Hg/lit/mt.
100 = 5X20
Peripheral vascular resistance: depends upon

A) Velocity of blood D) Lumen of the vessels

B) Viscosity of blood E) Length of the vessels

F) Extra vascular
C) Elasticity of the compression
vessels wall
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 Peripheral Resistance
P.R.U unit: (Relative unit) When there is a
difference of 1 mm Hg and a flow of 1ml/sec
then it is called one PRU unit.
Obsolute units: Dyne/sec/cm2

Pressure dyne/cm2
PR =
Flow cc/sec

= dyne/sec/cm2

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 Ernest H. Starling in the dog lab (1915)

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 FACTORS CONTRIBUTING
TO BLOOD PRESSURE

1 Cardiac output-VR,HR,FOC—S.P
2. PERIPHERAL RESISTANCE

Radius of BV Velocity
DP
Elasticity Viscosity

Extra vascular
compression Length of BV
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 MAP
CO TPR
HR SV ANS
Hormones
EDV Viscosity
ANS
Blood vessel length
Hormones
Venous Return Blood vessel diameter
Brain
Local factors
Kidney
Respiratory pump
Angiotensin Skeletal muscle pump
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Aldosterone
ADH
 REGULATION OF ARTERIAL
BLOOD PRESSURE

 Immediate mechanism
 Short term mechanism
 Long term mechanism

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mmediate Regulatory Mechanisms:
Neural mechanisms

1. Baroreceptor
reflexes

2. Chemo receptor
reflexes
3. Cerebral ischaemic
response
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 BARORECEPTOR REFLEX

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BARO RECEPTOR REFLEXES (MAREY’S REFLEXES)
BP↑
↓
Stimulation of baroreceptors
(carotid sinus and aortic arch)
↓
Tractus solitarius stimulation

Inhibition of VMC Stimulation of CIC

(nucleus ambiguous)

SNS Vagus
BP
↓ Symp tone Vagal tone ↑

Blood Vessels Heart Rate Decreased

- Vasodilatation
02/16/16 - Venodilatation Bradycardia
 BARORECEPTOR REFLEX

Net effect

↓ Peripheral resistance

↓ Myocardial contractility

↓ Heart rate (Bradycardia)

↓ Fall in BP

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 Chemo receptor reflexes
↓ BP <60 mm Hg

Hypoxia

Chemoreceptors

NTS Respiratory centre CIC

VMC stimulation N ambiguus

Vagus

SNS action↑ ↓ Vagaltone

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Net effect ↑ Pulmonary ventilation, ↑ BP, ↑ Heart rate

 Cerebral Ischaemic Response
↓ BP < 40 mm Hg (or)
↑ Intracranial pressure

Cerebra ischaemia

Cerebral hypoxia

Direct effect on
VMC

SNS action ↑

Vasoconstriction Cushing’s Reflex

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↑ BP with reflex
bradycardia
 REGULATION OF ARTERIAL
BLOOD PRESSURE
rm regulatory mechanisms:
are again
d into
regulatory
nisms
ed regulatory
nisms.

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 Delayed or Intermediate Mechanism

Capillary fluid shift phenomenon:

Whenever there is an increase in blood pressure
more fluid is filtered through the capillary wall into
the interstitial space.

Blood volume decreases

and so BP itself decreases.

Reverse changes take

place when BP falls.
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 Delayed or Intermediate Mechanism
Renin –Angiotensin System
Whenever there is a fall in B.P, there is a
decrease in the blood flow to the kidney.
This results is ischaemic kidney.
Renin is released from J.G. cells
Renin
Angiotensin Angiotensin I
ACE
Angiotensin I Angiotensin II

ACE - Angiotensin Converting Enzyme

( Present in the lungs)
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 ACTION OF ANGIOTENSIN - II

1. Vasoconstriction
2. Aldosterone secretion
3. Stimulation of the
thirst centre
4. Increased absorption
of Na+ from PCT by
direct effect. As a result

. B.V ↑, C.O ↑. BP ↑
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Tuesday, February 16, 2016
ess Relaxation Phenomenon:
↑BP

Blood vessels are stretched

Stress relaxation

Increased capacity

Decreased effective
blood volume

BP decreased
relaxation
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↓BP
rm Regulatory Mechanisms:

ll the mechanisms
hat tend to alter the
blood volume
participate in
ong term regulatory
mechanisms

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 Renal –body fluid system:

↑ECF or Blood volume ↓ECF or Blood volume

- ↑ BP - ↓BP

↑ GFR ↑ urine output ↓ GFR BP ↓ urine output

B.P is brought back to B.P is slowly raised to

the normal level the normal level.

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 HORMONAL REGULATIONS
1) Catecholamines
2) Mineralocorticocoid
3) Glucocorticoid
4) Thyroxine
5) ADH
6) Atrial Natriuretic Factor
7) Nitric Oxide
8) Histamine
9) Angiotensin
10) Serotonin

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 Hypertension
 Defined as an elevation of systolic
blood pressure
 Persistent hypertension very common
 30% of people over 50 are
hypertensive
 Never diagnosed on one reading
 Indication of cardiovascular disease
 Trauma
 Side effect of medication
 ↑ BP is called Hypertension
(Above 140/90 mm of Hg )
Primary Secondary
(Essential 90%) (10%)

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 Diseases Attributable to
Hypertension
Stroke
Coronary heart disease
Heart failure

Cerebral hemorrhage
Myocardial infarction

Left ventricular
hypertrophy Hypertension Chronic kidney failure

Hypertensive
Aortic aneurysm encephalopathy
Retinopathy
Peripheral vascular disease
All
Vascular

Adapted from: Arch Intern Med 1996; 156:1926-1935.

 Hypertension
Predisposing factors:
 Obesity
 Hereditary
 Alchoholism
 Stress
 Smoking
 Sedentary life
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 Secondary Hypertension
Causes:
 1.Renal-Acute & Chronic
Glomerulonephritis,Nephrotic syndrome
 2.Endocrine-
Cushings,Conns,Thyrotoxicosis,
Pheochromacytoma
 3.Vascular-Atherosclerosis

Arteriosclerosis
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 Treatment of Hypertension
Modification of lifestyle:
 Cessation of smoking.
 Moderation in alcohol intake.

 Weight reduction.

 Programmed exercise.

 Reduction in Na+ intake.

 Diet high in K+.

 Relaxation technique – Yoga, TM

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 Treatment of Hypertension
 Medications:
 Diuretics:
 Increase urine volume.
 Beta-blockers:
 Decrease HR.
 Calcium antagonists:
 Block Ca2+ channels.
 ACE inhibitors:
 Inhibit conversion to angiotensin II.
 Angiotension II-receptor antagonists:
 Block receptors.

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 Prevention
 Reduce the risk of developing High Blood
Pressure by making lifestyle changes…..
 Eat a healthy , well balanced diet
 Reduce salt and fat intake
 Exercise regularly
 Stop smoking
 Reduce alcohol and caffeine consumption to
recommended levels
 Reduce weight
 Hypotension

 Defined in adults as a
systolic pressure below
100mm Hg
 Rarely treated in this
country
 ↓ BP is called Hypotension
(Below 90/60 mm of Hg)

1. Hemorrhage
2. Dehydration
3. Vomiting
4. Diarrhea
5. Excessive
sweating
6.Adissons disease
7.Hypothyroidism

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 Treatment of Hypotension
Treat the cause
Blood transfusion
I.V. Fluids
Vasoconstrictors

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 RECAP
At the end of this class, you should able to
recall.
1. Definition of Blood Pressure
2. Its variations.
3. Measurement - Korotkov sound
4. Factors contributing to B.P
5. Peripheral resistance
6. Regulation of BP
7. Immediate regulation
8. Short term regulation
9. Long term regulation.
10. Applied - Hypertension - Hypotension
02/16/16
Success is one percent
inspiration
And
ninety nine percent
perspiration

02/16/16
Thank You