Physiology: Nervous Regulation of the
Circulation and Rapid Control of Arterial
Pressure
Autonomic Nervous System (ANS):
1- Sympathetic Nervous System (SNS):
The sympathetic nervous system is often referred to as the "fight
or flight" system. When activated, it prepares the body for action
by increasing heart rate, cardiac contractility, and
vasoconstriction of certain blood vessels. These actions
collectively increase blood pressure and redirect blood flow to the
muscles and organs needed for immediate physical activity.
Sympathetic nerves release norepinephrine, which binds to
adrenergic receptors on cardiac cells and blood vessel smooth
muscle, leading to these effects.
2- Parasympathetic Nervous System (PNS):
The parasympathetic nervous system is responsible for
the "rest and digest" functions. It opposes the actions of
the sympathetic nervous system by reducing heart rate
and promoting vasodilation in certain blood vessels.
Acetylcholine is the neurotransmitter released by
parasympathetic nerves, and it acts on cardiac cells to
slow heart rate and on blood vessels to promote dilation
Local Reflexes:
1- Metabolic Autoregulation:
Tissues and organs can regulate their own blood flow based on their
metabolic needs. When tissues are metabolically active and require
more oxygen and nutrients, they release vasodilatory substances
such as adenosine and nitric oxide, which relax blood vessel smooth
muscle and increase blood flow to the area. Conversely, when tissues
have lower metabolic demands, local vasoconstrictor mechanisms
can decrease blood flow to conserve resources.
2-Myogenic Autoregulation:
Some blood vessels can also regulate their diameter in
response to changes in pressure. When blood pressure
increases, the smooth muscle in the vessel wall
contracts (vasoconstriction) to maintain a constant
blood flow. If blood pressure decreases, the vessel
dilates (vasodilation) to maintain blood flow to the
tissue.
3- Baroreceptor Reflex:
3.1- Baroreceptors are specialized sensory receptors located in
the walls of certain blood vessels, primarily in the carotid sinuses
(in the carotid arteries in the neck) and the aortic arch. These
receptors continuously monitor changes in blood pressure. When
blood pressure increases, baroreceptors are stretched, and they
send signals to the brain (specifically, the medulla oblongata) to
reduce sympathetic nervous system activity and increase
parasympathetic activity.
This leads to the following responses:
-Decreased heart rate (bradycardia)
-Vasodilation of blood vessels
-Decreased cardiac contractility
-Reduced cardiac output
3.2- Chemoreceptor Reflex:
Chemoreceptors, located in the carotid and aortic
bodies, monitor the levels of oxygen (O2), carbon
dioxide (CO2), and pH in the blood. When oxygen levels
decrease (hypoxia) or carbon dioxide levels increase
(hypercapnia), these chemoreceptors send signals to
the brain, particularly the medulla oblongata. In
response, the sympathetic nervous system is activated,
leading to an increase in heart rate and an increase in
arterial pressure to improve oxygen delivery and
remove excess carbon dioxide.
3.3- Renin-Angiotensin-Aldosterone System (RAAS):
The RAAS is a hormonal mechanism that can rapidly
influence arterial pressure. When there is a decrease in blood
flow to the kidneys or a drop in blood pressure, the kidneys
release an enzyme called renin. Renin catalyzes the
conversion of angiotensinogen to angiotensin I, which is
further converted to angiotensin II. Angiotensin II is a potent
vasoconstrictor that narrows blood vessels, increasing
peripheral resistance and blood pressure. It also stimulates
the release of aldosterone, which promotes sodium and
water retention by the kidneys, further increasing blood
volume and arterial pressure.
3.4- Central Nervous System Ischemic Response:
In situations where there is inadequate blood flow to the brain
(cerebral ischemia), specialized neurons in the brain can trigger a
sympathetic response to increase arterial pressure. This response
involves increasing heart rate, cardiac contractility, and peripheral
vasoconstriction to maintain brain perfusion.
Hormonal Control of Blood Pressure
Hormones such as epinephrine,
norepinephrine, and vasopressin can
increase blood pressure by increasing
heart rate and vasoconstriction.
Conversely, hormones such as atrial
natriuretic peptide and nitric oxide can
decrease blood pressure by promoting
vasodilation and decreasing fluid volume.
Pathophysiology of Blood Pressure Regulation
Dysfunction in any of the neural, central,
reflex, or hormonal mechanisms involved in
blood pressure regulation can lead to
hypertension or hypotension. Hypertension
can increase the risk of cardiovascular
disease, while hypotension can lead to
organ damage and shock.