The meaning of blood pressure

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Abstract

Measurement of arterial pressure is one of the most basic elements of patient management. Arterial pressure is determined by the volume ejected by the heart into the arteries, the elastance of the walls of the arteries, and the rate at which the blood flows out of the arteries. This review will discuss the three forces that determine the pressure in a vessel: elastic, kinetic, and gravitational energy. Emphasis will be placed on the importance of the distribution of arterial resistances, the elastance of the walls of the large vessels, and critical closing pressures in small arteries and arterioles. Regulation of arterial pressure occurs through changes in cardiac output and changes in vascular resistance, but these two controlled variables can sometimes be in conflict.

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Most cited references 43

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The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine.

Robert F. Furchgott, John Zawadzki (1980)

Despite its very potent vasodilating action in vivo, acetylcholine (ACh) does not always produce relaxation of isolated preparations of blood vessels in vitro. For example, in the helical strip of the rabbit descending thoracic aorta, the only reported response to ACh has been graded contractions, occurring at concentrations above 0.1 muM and mediated by muscarinic receptors. Recently, we observed that in a ring preparation from the rabbit thoracic aorta, ACh produced marked relaxation at concentrations lower than those required to produce contraction (confirming an earlier report by Jelliffe). In investigating this apparent discrepancy, we discovered that the loss of relaxation of ACh in the case of the strip was the result of unintentional rubbing of its intimal surface against foreign surfaces during its preparation. If care was taken to avoid rubbing of the intimal surface during preparation, the tissue, whether ring, transverse strip or helical strip, always exhibited relaxation to ACh, and the possibility was considered that rubbing of the intimal surface had removed endothelial cells. We demonstrate here that relaxation of isolated preparations of rabbit thoracic aorta and other blood vessels by ACh requires the presence of endothelial cells, and that ACh, acting on muscarinic receptors of these cells, stimulates release of a substance(s) that causes relaxation of the vascular smooth muscle. We propose that this may be one of the principal mechanisms for ACh-induced vasodilation in vivo. Preliminary reports on some aspects of the work have been reported elsewhere.

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The L-arginine-nitric oxide pathway.

S Moncada, A Higgs (1993)

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Left ventricular interaction with arterial load studied in isolated canine ventricle.

Benjamin L Maughan, K Sunagawa, K Sagawa … (1983)

We developed a framework of analysis to predict the stroke volume (SV) resulting from the complex mechanical interaction between the ventricle and its arterial system. In this analysis, we characterized both the left ventricle and the arterial system by their end systolic pressure (Ps)-SV relationships and predicted SV from the intersection of the two relationship lines. The final output of the analysis was a formula that gives the SV for a given preload as a function of the ventricular properties (Ees, V0, and ejection time) and the arterial impedance properties (modeled in terms of a 3-element Windkessel). To test the validity of this framework for analyzing the ventriculoarterial interaction, we first determined the ventricular properties under a specific set of control arterial impedance conditions. With the ventricular properties thus obtained, we used the analytical formula to predict SVs under various combinations of noncontrol arterial impedance conditions and four preloads. The predicted SVs were compared with those measured while actually imposing the identical set of arterial impedance conditions and preload in eight isolated canine ventricles. The predicted SV was highly correlated (P less than 0.0001) with the measured one in all ventricles. The average correlation coefficient was 0.985 +/- 0.004 (SE), the slope 1.00 +/- 0.04, and the gamma-axis intercept 1.0 +/- 0.2 ml, indicating the accuracy of the prediction. We conclude that the representations of ventricle and arterial system by their Ps-SV relationships are useful in understanding how these two systems determine SV when they are coupled and interact.

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Author and article information

Contributors

S. Magder: sheldon.magder@mcgill.ca

Journal

Journal ID (nlm-ta): Crit Care

Title: Critical Care

Publisher: BioMed Central (London )

ISSN (Print): 1364-8535

ISSN (Electronic): 1466-609X

Publication date (Electronic): 11 October 2018

Publication date PMC-release: 11 October 2018

Publication date Collection: 2018

Volume: 22

Electronic Location Identifier: 257

Affiliations

ISNI 0000 0000 9064 4811, GRID grid.63984.30, Department of Critical Care, , McGill University Health Centre, ; 1001 Decarie Blvd., Montreal, Quebec H4A 3J1 Canada

Article

Publisher ID: 2171

DOI: 10.1186/s13054-018-2171-1

PMC ID: 6180453

PubMed ID: 30305136

SO-VID: dc0fada4-8a35-4989-98d0-690967df4af0

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 29 January 2018

Date accepted : 27 August 2018

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ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: arterial resistance,conductance,critical closing pressure,cardiac output,blood flow,perfusion,gravitational energy,elastic energy,kinetic energy

Data availability:

ScienceOpen disciplines: Emergency medicine & Trauma

Keywords: arterial resistance, conductance, critical closing pressure, cardiac output, blood flow, perfusion, gravitational energy, elastic energy, kinetic energy

The meaning of blood pressure

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Abstract

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Irish Journal of Paramedicine

Most cited references 43

The obligatory role of endothelial cells in the relaxation of arterial smooth muscle by acetylcholine.

The L-arginine-nitric oxide pathway.

Left ventricular interaction with arterial load studied in isolated canine ventricle.

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