Vital Signs: Blood Pressure

Video 2.1: Introduction to the Blood Vessels

Anatomy of the blood vessels
-

Five types of blood vessels:

o arteries
o

arterioles

capillaries site of gas exchange

venules

veins

Two circulations
o Systemic circulation:

arteries carry blood to capillaries

in the capillary beds, oxygen (O2)leaves blood and moves to
tissues and carbon dioxide (CO2) moves from the tissues to the
blood
deoxygenated blood is then brought back to the right side of the
heart through systemic veins
aorta carries blood into the systemic circulation

aorta branches into smaller arteries

branching continues until vessels are small enough that
they are called arterioles

small arterioles carry blood to capillaries

capillaries converge to form venules

venules converge and form veins

Pulmonary circulation:

pulmonary trunk carries deoxygenated blood into the pulmonary

circulation

it branches into R. & L. pulmonary arteries, which carry

blood to the R. & L. lungs, respectively
gas exchange occurs in pulmonary capillaries

pulmonary veins carry oxygenated blood back to the left side of

the heart

Video 2.2: Blood Vessel Structure

All blood vessels except the capillaries have walls consisting of 3 layers
-

tunica intima

innermost layer is called endothelium it is continuous with

endocardium of the heart
thin, smooth tissue low friction for blood flow

directly surrounds the lumen:

endothelium is the only tissue layer in capillaries

tunica media
o

contains many elastic and smooth muscle fibers

elastic fibers - able to distend and retract
smooth muscle is arranged in concentric layers around the wall
of the vessel
when the smooth muscle contracts, it causes the vessel
diameter to decrease in size this is called
vasoconstriction
conversely, when the smooth muscle relaxes, the vessel
diameter increases this is called vasodilation

innervated by the sympathetic nervous system

o

even at rest, the sympathetic nervous system is

sending signals to the vascular smooth muscle,
causing a baseline level of vasoconstriction

higher level of sympathetic outflow, cause greater

stimulation of the smooth muscle which can cause
greater amount of vasoconstriction

tunica externa
o
o

made of a layer of connective tissue

anchors the blood vessel in place and helps protect the outside of the
vessel

Specific Type of Blood Vessels- Structure and Function

-

3 general types of arteries:

o elastic arteries
closest to heart
tunica media contains relatively more elastic fibers
these large arteries have to be able to distend during ventricular
systole to compensate for the surge of blood
then, the vessels retract during diastole, maintaining pressure
which allows for a continuous flow of blood

muscular arteries
tunica media contains more smooth muscle

because there is more smooth muscle in the vessel walls, these

vessels have a greater ability to vasoconstrict or vasodilate,,
which allows them to channel blood to different organs or
regions of the body

arterioles
large amount of smooth muscle in tunica media
very responsive to signals from the sympathetic nervous
system in terms of vasoconstricting or vasodilating

atherosclerosis

these vessels have a big impact on vascular resistance

veins
o venous walls are always thinner than an arterial wall that is the same
distance away from the heart

o
o
o

thin, collapsible walls which distend and collapse easily

veins have relatively large lumen diameters
due to the structure of veins, venous pressure is low

Video 2.3: Blood Circulation

Blood Circulation
- heart beats intermittently yet blood flows continuously
- blood flow = volume of blood that moves through a level of the vascular
system per minute
o blood flow is equal to cardiac output (CO)
o

blood pressure = force exerted per unit of surface area against the inner
walls of a blood vessel
o
o

blood flow is fairly constant under resting conditions

unit of measurement is millimeters of mercury (mmHg)

blood flows from region of high pressure to region of low pressure

resistance = anything that opposes, or impedes, blood flow

o

most resistance is in the systemic circulation, away from heart called

peripheral resistance

influenced by several factors:

vessel diameter

#1 factor responsible for changes in vascular resistance

arterioles are most responsible for changes in peripheral
resistance

blood viscosity- thickness or thinness of the blood

is fairly constant in healthy people

o anemia
o

polycythemia

vessel length

pulmonary vs. systemic circulation-

Video 2.4a: Maintaining Blood Flow

-

pressure gradient difference in pressure from one part of the vascular

system to another
o

blood flows down its pressure gradient

pressure across the systemic circulation

o

systolic pressure (SBP)

diastolic pressure (DBP)

generated by ventricular contraction

= the highest pressure achieved in the large arteries

achieved during ventricular relaxation

= the lowest pressure in the large arteries, achieved at the end
of ventricular diastole
during diastole, elastic arteries retract to maintain pressure
diastolic pressure is lower than systolic pressure

mean arterial pressure (MAP)

highest MAP occurs in large arteries

lower in smaller arteries due to increased resistance
decreases across the capillary beds
lowest in the large veins close to the heart

MAP continues to drop in the veins- several features help to maintain blood
flow through the veins even though pressure is low
o venous valves --prevent backward flow of blood
o

skeletal muscles
muscles bulge when contracted -- pushes on veins to send blood
to heart
then, during muscular relaxation, venous valves prevent
backflow

pressure changes in the thoracic cavity during breathing lower

thoracic cavity pressure during inhalation helps return blood to the
heart

Video 2.4b: Assessing Blood Pressure Demonstration

To take a blood pressure:
- gather necessary equipment:
o inflatable cuff attached to a sphygmomanometer
make sure the cuff is the correct size if cuff size is wrong, the
BP readings will not be accurate
o

stethoscope

apply the cuffo line up artery marker with brachial artery

o cuff bottom should be in crook of the elbow (i.e., the antecubital fossa)

taking the pressure

o ideally, take the reading in the left arm and support the arm at the
same level of the heart to get the most accurate reading
o inflate the pump this will cause cuff to inflate, occluding arteries
under the cuff

arteries collapse, preventing blood flow

release gauge to deflate cuff
listen to brachial artery will be quiet until blood flow is no
longer occluded
Korotkoff sounds

note first sound and last sound

systolic pressure corresponds to the first Korotkoff

sound

diastolic pressure sound of turbulent flow stops

because blood is flowing smoothly through the artery
again
blood pressure reading of 110 over 62 (110/62) SBP is
top number, DBP is bottom number

Video 2.5: Blood Pressure Regulation

Normal and abnormal blood pressure
- In healthy adults, systolic blood pressure should be no higher than 120 mmHg
and diastolic should be less than 80 mmHg
- low blood pressure (hypotension)
o typically not a problem unless it interferes with the ability to carry
blood to the tissues
-

hypertension---i.e., high blood pressure

o can cause damage to blood vessel endothelium
over time, leads to narrowing of lumen and blood flow restriction
o

damage to heart
increased workload

structural changes

one can have hypertension and not experience symptoms because

untreated hypertension can damage the cardiovascular system, it is
important to have BP assessed regularly and treat hypertension

Factors affecting mean arterial pressure

- cardiac output

resistance
o arterioles create the most vascular resistance

cardiovascular regulatory centersin brainstem

receive input from baroreceptors these are sensors in blood

vessel walls that detect the level of stretch in the blood vessel
walls

regulate pressure by changing vessel diameter and cardiac

output

blood volume
o normally is fairly constant
o long term mechanisms involving hormonal regulation and kidney
function can change blood volume which then lead to changes in blood
pressure