Blood pressure control Contin. Reflex Mechanisms. Dr. Hiwa Shafiq

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1 Blood pressure control Contin. Reflex Mechanisms Dr. Hiwa Shafiq

2 A. Baroreceptor reflexes Baroreceptors (stretch receptors) located in the walls of several large systemic arteries( specially carotid artery and arch of aorta). A rise in arterial pressure stretches the baroreceptors and causes them to transmit signals into VMC. Feedback signals are then sent back through the autonomic nervous system to the circulation to reduce arterial pressure downward toward the normal level.

3 B. Carotid and aortic chemoreceptors The chemoreceptors (carotid and aortic bodies) lie in the bifurcation of each common carotid artery and aorta respectively These chemosensitive cells are supplied with abundant blood flow and are sensitive to oxygen lack. Whenever the arterial pressure falls below a critical level (80 mm Hg), they become stimulated due to diminished oxygen and buildup of CO2 and hydrogen ions. They excite the vasomotor center elevating the arterial pressure back toward normal.

4 The baroreceptor/chemoreceptor system for controlling arterial pressure

5 C. VMC ischemic response The vasomotor center becomes strongly excited when its blood flow becomes decreased severely enough to cause nutritional (cerebral) ischemia. Local concentration of carbon dioxide has an extremely potent effect in stimulating the sympathetic vasomotor nervous control areas in the medulla. The degree of sympathetic vasoconstriction caused by intense cerebral ischemia is often so great that some of the peripheral vessels become totally or almost totally occluded. Only the blood pressure below 60 mm Hg can stimulate VMC or CNS ischemic response

6 D. Atrial and pulmonary Artery Reflexes In the walls of both the atria and the pulmonary arteries (low pressure areas) are low-pressure receptors that detect increases in pressure caused by increased blood volume. They elicit reflexes parallel to the baroreceptor reflexes

7 The Renin-Angiotensin System: Its role in intermediate-term pressure control and in hypertension The kidneys have a powerful mechanism for controlling pressure called the renin-angiotensin system. Renin is a protein enzyme released by the kidneys when the arterial pressure falls too low. In turn, it raises the arterial pressure.

8 Renin-angiotensin vasoconstrictor mechanism for arterial pressure control Angiotensinogen (from liver)

9 Role of the Renin-Angiotensin system in maintaining a normal arterial pressure despite wide variations in salt intake. Sequential events by which increased salt intake increases the arterial pressure, but feedback decrease in activity of the renin angiotensin system returns the arterial pressure almost to the normal level.

10 Q/ Describe the response of body to salt intake and explain the negative feedback mechanism related to it.

11 long-term regulation of arterial pressure (Role of the Kidney) For long-term survival, fluid intake and output must be precisely balanced, a task that is performed by multiple nervous and hormonal controls, and the kidneys that regulate excretion of salt and water. An increase in arterial pressure in the human of only a few millimeters of mercury can double renal output of water, which is called pressure diuresis, as well as double the output of salt, which is called pressure natriuresis.

12 The two primary determinants of the long-term arterial pressure level are 1. Renal output of salt and water 2. Intake of salt and water It is impossible to change the longterm mean arterial pressure level to a new value without changing one or both of the two basic determinants of long-term arterial pressure.

13 Sequential steps by which increased ECF volume increases the arterial pressure.

14 Why increase in salt intake is more likely to elevate the arterial pressure than an increase in water intake? A) Pure water is normally excreted by the kidneys as rapidly as it is ingested, but salt is not excreted so easily. B) And salt increases the extracellular fluid volume because 1. Salt stimulates the thirst center in the brain making the person drink extra water to return the extracellular salt concentration to normal 2. Salt stimulates the release of vasopressin (ADH) from posterior pituitary causing water reabsorption by the kidneys.

15 Primary Hypertension (Essential Hypertension) About 90 to 95% of all people who have hypertension are said to have primary hypertension essential hypertension. These terms mean simply that the hypertension is of unknown origin, in contrast to those forms of hypertension that are secondary to known causes, such as renal artery stenosis. In some patients there is a strong hereditary tendency to develop the hypertension.

16 In most patients, excess weight gain and sedentary lifestyle appear to play a major role in causing hypertension. New clinical guidelines for treating hypertension recommend increased physical activity and weight loss as a first step in treating most patients with hypertension.

17 Features of primary hypertension 1. Cardiac output is increased to match the blood flow to the extra adipose tissue and to match the increased growth and metabolic rate by different organs (heart, GIT, kidneys etc ). 2. Sympathetic nerve activity, especially in the kidneys, is increased in overweight patients. 3. Angiotensin II and aldosterone levels are increased two- to threefold in many obese patients. 4. The renal-pressure natriuresis mechanism is impaired, and the kidneys will not excrete adequate amounts of salt and water unless the arterial pressure is high or unless kidney function is improved

18 Summary of the Integrated System for Arterial Pressure Regulation The arterial pressure is regulated not by a single pressure controlling system but instead by several interrelated systems, each of which performs a specific function. These mechanisms can be divided into three groups: (1) those that react rapidly, within seconds or minutes; (2) those that respond over an intermediate time period, minutes or hours (3) those that provide long-term arterial pressure regulation, days, months, and years

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