Blood pressure, blood flow, and

resistance
Content Reviewers:
Rishi Desai, MD, MPH, Yifan Xiao M.D.

Pressure is a force over an area, so with blood pressure, we're measuring the force
that the blood exerts on the surface area of the walls of the blood vessels.
Differences in blood pressure throughout the body keep blood flowing from high-
pressure areas, like the arteries, to low-pressure areas, like the veins. When we say
“blood flow,” we’re referring to the volume of blood that flows through a vessel or an
organ over some period of time. Now, the amount of blood flow from one end of a
blood vessel to another is affected by the blood pressure, and by the resistance,
which comes from the vessels themselves. Vasoconstriction, where the vessels
constrict, decreases blood flow, and vasodilation, where the blood vessels expand,
increases blood flow.
Now, blood flow is not the same thing as the velocity of blood. Blood flow is
the volume of blood that moves by a point over some period of time. So let’s say this
chunk of blood has a volume of 83 cm^3, and it took 1 second for this much to flow
past the blue circle—this is the blood flow, represented by the variable capital Q.
Now, velocity on the other hand, is the distance traveled in a certain amount of time.
So maybe in the same one second, a red blood cell at the very edge here traveled a
distance of 27 cm, then it’d be moving 27 cm/s, represented by lowercase v. Even
though these aren’t equal, they are related, and the last piece is area, specifically the
cross-sectional area of the blood vessel, which in reality is the same as the blood
cross section like this. So, based on units, since area’s going to be expressed
in cm^2, we see that flow rate equals area times velocity! Alright, so for example,
let’s say we want to calculate blood velocity, and we have a person’s cardiac
output of 5L/min, which is average for an adult, and the diameter of their aorta, which
is 2cm.
First off, using the equation for the area of a circle, (D/2)^2 x pi, we get (2 / 2)^2
x pi = 3.14 cm^2. Next, since cardiac output is the same as blood flow, we just need
to convert this L/min to cubic cm per second, so there are 1000 cubic cm in a L, and
60 seconds in a minute, so multiplying those out we get 83 cubic cm per second.
Then, rearranging our little formula, velocity equals flow rate divided by area, and we
get about 26 cm per second! Which is also about 1 km / hr!
Going back to blood pressure, blood flow, and resistance, that relationship can be
written out mathematically as well. So, to start, you have an initial, higher pressure at
one end, and a final, lower pressure at the other. The difference between these, or
the initial minus the final pressure, sometimes expressed as delta P, equals blood
flow through that vessel multiplied by resistance. This can be also written as Q
equals change in pressure over resistance. So, for example, let’s say the the blood
vessel narrows, which increases the resistance, in order to keep the flow of blood to
organs the same, the pressure difference has to increase, and this is typically what
happens. This equation might look familiar to a similar equation, where change
in voltage V equals current I times resistance R, also known as ohm’s law!
Okay, let’s talk about pressure. Blood pressure is usually highest in a large artery
like the brachial artery, which is where blood pressure is usually measured, That’s
because at that point the blood still needs to be able to push through the smaller
arterioles and capillaries, which means lots of resistance. In an average adult, blood
pressure is about 120/80 mmHg or millimeters of mercury. That might look like a
fraction, but it’s not. The first number, 120, is the systolic pressure, which is the force
that the blood exerts on the walls of the arteries during systole, when the heart
contracts to pump blood through the body, and the second number, 80, is
the diastolic pressure, which is the pressure on the walls of the arteries
during diastole, when the heart relaxes and refills with blood between heartbeats.
That’s why the first number is bigger: the arteries are under more pressure when
there’s more force from the heart pushing the blood.
The mean arterial pressure, or MAP, is the average pressure on the arteries during a
complete cardiac cycle, including the systolic and diastolic pressures. It can be
calculated a couple ways. The first is the quickest: we assume that about ⅓ of
the cardiac cycle is spent in systole and about ⅔ of the cardiac cycle is spent
in diastole and say that the MAP = ⅓ (systolic blood pressure) + ⅔ (diastolic blood
pressure). Another measuremnt is the pulse pressure, which is the difference
between the systolic pressure and the diastolic pressure, so in our example, it would
be 120 - 80 or 40 mm Hg. So another way to figure it out is to say that MAP = ⅓
(pulse pressure) + diastolic pressure, which is exactly the same thing, but just written
differently.
Now, a completely different way to think about MAP is by using the relationship
between blood pressure, blood flow, and resistance. Let’s go back to our big artery,
say this time it’s the aorta, the biggest of the arteries coming right from the heart
itself. That artery goes to arterioles and capillaries, representing the whole human
body, and then the venous blood returns to the right atrium of the heart. So in this
zoomed out view, the initial pressure here is pressure in the arteries, in other
words—the mean arterial pressure, and the final pressure over here is we have
the central venous pressure, or CVP, in the vena cavae right before they enter
the right atrium.
Looking back at our equation, Pi - Pf = Q x R, blood flow is the total blood
flow through all of the blood vessels and organs, which is called the cardiac
output and is measured in L/min. Pi is MAP and Pf is CVP, and finally, the combined
resistance of all of the blood vessels of systemic circulation would be the systemic
vascular resistance, called SVR,. So the equation is MAP - CVP = CO x SVR. CVP
is usually a small number, so it’s usually ignored and the equation is simplified to
MAP = CO x SVR. Based on this relationship, you can see why for example, an
increase in resistance, which is mostly caused by arteriole vasoconstriction, will
cause the blood pressure to rise.

SUMMARY

All right, as a quick recap: blood pressure refers to the force the blood exerts on the
blood vessels, blood flow refers to the volume of blood that flows through the blood
vessels, an organ, or the entire body, over a certain amount of time, and resistance
refers to the physical and mechanical pushback the blood gets from things
like vasoconstriction.