BLOOD and CIRCULATION

FUNCTIONS OF THE CIRCULATORY SYSTEM

The blood vessels of the body form a network more complex than an interstate
highway system. The blood vessels carry blood to within two or three cell diameters of
nearly all the trillions of cells that make up the body. Blood flow through them is
regulated, so that cells receive adequate nutrients and so that waste products are
removed.

Blood vessels remain functional, in most cases, in excess of 70 years, and when they
are damaged, they repair themselves. Blood vessels outside the heart are divided into
two classes: (1)the pulmonary vessels, which transport blood from the right ventricle
of the heart through the lungs and back to the left atrium, and (2) the systemic
vessels, which transport blood through all parts of the body, from the left ventricle of
the heart and back to the right atrium. Together, the pulmonary vessels and the
systemic vessels constitute the circulatory system.

The heart provides the major force that causes blood to circulate, and the circulatory
system has five functions:
1. Carries blood. Blood vessels carry blood from the heart to all the tissues of the
body and back to the heart.
2. Exchanges nutrients, waste products, and gases with tissues. Nutrients and
oxygen diffuse from blood vessels to cells in essentially all areas of the body. Waste
products and carbon dioxide diffuse from the cells, where they are produced, to blood
vessels.
3. Transports substances. Blood transports hormones, components of the immune
system, molecules required for coagulation, enzymes, nutrients, gases, waste
products, and other substances to all areas of the body.
4. Helps regulate blood pressure. The circulatory system and the heart work together
to regulate blood pressure within a normal range.
5. Directs blood flow to the tissues. The circulatory system directs blood to tissues
when increased blood flow is required to maintain homeostasis.

GENERAL FEATURES OF BLOOD VESSEL STRUCTURE

The three main types of blood vessels are arteries, capillaries, and veins. Arteries (ar′
ter-ēz) carry blood away from the heart; usually, the blood is oxygen-rich.

Blood is pumped from the ventricles of the heart into large, elastic arteries, which
branch repeatedly to form progressively smaller arteries. As they become smaller, the
artery walls undergo a gradual transition from having more elastic tissue than smooth
muscle to having more smooth muscle than elastic tissue. The arteries are normally
classified
as elastic arteries, muscular arteries, or arterioles, although they form a continuum from
the largest to the smallest branches.
Blood flows from arterioles into capillaries (kap′ i-lār-ēz), where exchange occurs
between the blood and the tissue fluid. Capillaries have thinner walls than do arteries
(figure 13.1d). Blood flows through them more slowly, and there are far more of them
than of any other blood vessel type.
From the capillaries, blood flows into veins. Veins (vānz) carry blood toward the heart;
usually, the blood is oxygen-poor. Compared to arteries, the walls of veins are thinner
and contain less elastic tissue and fewer smooth muscle cells (figure 13.1e–g). Starting
at capillaries and proceeding toward the heart, small-diameter veins come together to
form larger-diameter veins, which are fewer in number. Veins increase in diameter and
decrease in number as they progress toward the heart, and their walls increase in
thickness. Veins may be classified as venules, small veins, medium-sized veins, or
large veins.
Except in capillaries and venules, blood vessel walls consist of three layers, or tunics
(too′ niks). From the inner to the outer wall, the tunics are (1) the tunica intima, (2) the
tunica media, and (3) the tunica adventitia, or tunica externa (figure 13.2; see figure
13.1).

The tunica intima (too′ ni-kăin′ ti-mă), or innermost layer, consists of an endothelium
composed of simple squamous epithe-lial cells, a basement membrane, and a small
amount of connective tissue. In muscular arteries, the tunica intima also contains a
layer of thin elastic connective tissue.
The tunica media, or middle layer, consists of smooth muscle cells arranged circularly
around the blood vessel. It also contains variable amounts of elastic and collagen
fibers, depending on the size and type of the vessel. In muscular arteries, a layer of
elastic connective tissue forms the outer margin of the tunica media. The tunica
adventitia (ad
ven-tish′ ă) is composed of dense connective tissue adjacent to the tunica media; the
tissue becomes loose connective tissue toward the outer portion of the blood vessel
wall.

Arteries
Elastic arteries are the largest-diameter arteries and have the thickest walls (see
figure 13.1a). Compared to other arteries, a greater proportion of their walls is
composed of elastic tissue, and a smaller proportion is smooth muscle. The aorta and
pulmonary trunk are examples of elastic arteries. Elastic arteries stretch when the
ventricles of the heart pump blood into them. The elastic recoil of these arteries
prevents blood pressure from falling rapidly and maintains blood flow while the
ventricles are relaxed.
The muscular arteries include medium-sized and small arteries. The walls of medium
sized arteries are relatively thick compared to their diameter. Most of the wall’s
thickness results from smooth muscle cells of the tunica media (see figure 13.1b).
Medium-sized arteries are frequently called distributing arteries because the smooth
muscle tissue enables these vessels to control blood flow to different body regions.
Contraction of the smooth muscle in blood vessels, called vasoconstriction (vā′ sō-
kon-strik′ shŭn), decreases blood vessel diameter and blood flow. Relaxation of the
smooth muscle in blood vessels, called vasodilation (vā′ sō-dı̆ -lā′ shŭn), increases
blood vessel diameter and blood flow.
Medium-sized arteries supply blood to small arteries. Small arteries have about the
same structure as the medium-sized arteries, except for a smaller diameter and thinner
walls. The smallest of the small arteries have only three or four layers of smooth muscle
in their walls.
Arterioles (ar-tēr′ ē-ōlz) transport blood from small arteries to capillaries. Arterioles
(see figure 13.1c) are the smallest arteries in which the three tunics can be identified;
the tunica media consists of only one or two layers of circular smooth muscle cells.
Small arteries and arterioles are adapted for vasodilation and vasoconstriction.

Capillaries
Blood flows from arterioles into capillaries, which branch to form networks (figure 13.3;
see figure 13.1d). Blood flow through capillaries is regulated by smooth muscle cells
called precapillary sphincters located at the origin of the branches. Capillary walls
consist of endothelium (en-dō-thē′ lē-ŭm), which is a layer of simple squamous
epithelium surrounded by delicate loose con-nective tissue. The thin walls of capillaries
facilitate diffusion between the capillaries and surrounding cells. Each capillary is 0.5–1
millimeter (mm) long. Capillaries branch without changing their diameter, which is
approximately the same as the diameter of a red blood cell (7.5 μm).
Red blood cells flow through most capillaries in single file and are frequently folded as
they pass through the smaller-diameter capillaries. As blood flows through capillaries,
blood gives up O2 and nutrients to the tissue spaces and takes up CO 2 and other by
products of metabolism. Capillary networks are more numerous and more extensive in
the lungs and in highly metabolic tissues, such as the liver, kidneys, skeletal muscle,
and cardiac muscle, than in other tissue types.

Veins
Blood flows from capillaries into venules and from venules into small veins. Venules
(ven′ oolz) have a diameter slightly larger than that of capillaries and are composed of
endothelium resting on a delicate connective tissue layer (see figure 13.1e). The
structure of venules, except for their diameter, is very similar to that of capillaries. Small
veins are slightly larger in diameter than venules. All three tunics are present in small
veins. The tunica media contains a continuous layer of smooth muscle cells, and the
connective tissue of the tunica adventitia surrounds the tunica media (see figure 13.1f ).

Medium-sized veins collect blood from small veins and deliver it to large veins. The
three thin but distinctive tunics make up the wall of the medium-sized and large veins.
The tunica media con-tains some circular smooth muscle and sparsely scattered
elastic fibers. The predominant layer is the outer tunica adventitia, which consists
primarily of dense collagen fibers (see figures 13.1g and 13.2). Consequently, veins
are more distensible than arteries. The connective tissue of the tunica adventitia
determines the degree to which they can distend.
Veins having diameters greater than 2 mm contain valves, which allow blood to flow
toward the heart but not in the opposite direction (figure 13.4). Each valve consists of
folds in the tunica intima that form two flaps, which are similar in shape and function to
the semilunar valves of the heart. There are many valves in medium-sized veins and
more valves in veins of the lower limbs than in veins of the upper limbs. This prevents
blood from flowing toward the feet in response to the pull of gravity.
BLOOD VESSELS OF THE PULMONARY CIRCULATION

The pulmonary circulation is the system of blood vessels that carries blood from the
right ventricle of the heart to the lungs and back to the left atrium of the heart. Blood
from the right ventricle is pumped into a short vessel called the pulmonary (pŭl′ mō-
nār-ē) trunk. The pulmonary trunk then branches into the right and left pulmonary
arteries, which extend to the right and left lungs, respectively. These arteries carry
oxygen-poor blood to the pulmonary capillaries in the lungs, where the blood takes up
O2 and releases CO2. Blood rich in O2 flows from the lungs to the left atrium. Four
pulmonary veins (two from each lung) exit the lungs and carry the oxygen-rich blood
to the left atrium.

BLOOD VESSELS OF THE SYSTEMIC CIRCULATION: ARTERIES

The systemic circulation is the system of blood vessels that carries blood from the left
ventricle of the heart to the tissues of the body and back to the right atrium. Oxygen-rich
blood from the pulmonary veins passes from the left atrium into the left ventricle and
from the left ventricle into the aorta. Arteries distribute blood from the aorta to all
portions of the body.

BLOOD VESSELS OF THE SYSTEMIC CIRCULATION: VEINS

The oxygen-poor blood from the tissues of the body returns to the heart through veins.
The superior vena cava (vē′ năkā′ vă) returns blood from the head, neck, thorax, and
upper limbs to the right atrium of the heart, and the inferior vena cava returns blood
from the abdomen, pelvis, and lower limbs to the right atrium.
PHYSIOLOGY OF CIRCULATION
The function of the circulatory system is to maintain adequate blood flow to all body
tissues. Adequate blood flow is required to provide nutrients and O 2 to the tissues and
to remove the waste products of metabolism from the tissues. Blood flows through the
arterial system primarily because of the pressure produced by contractions of the heart
ventricles.

Blood Pressure
Blood pressure is a measure of the force blood exerts against the blood vessel walls.
In arteries, blood pressure values go through a cycle that depends on the rhythmic
contractions of the heart. When the ventricles contract, blood is forced into the arteries,
and the pressure reaches a maximum value called the systolic pressure.
When the ventricles relax, blood pressure in the arteries falls to a minimum value called
the diastolic pressure. The standard unit for measuring blood pressure is millimeters
of mercury (mm Hg). For example, if the blood pressure is 100 mm Hg, the pressure is
great enough to lift a column of mercury 100 mm.
Health professionals most often use the auscultatory (aws-kŭl′ tă-tō-rē; to listen)
method to determine blood pressure. A blood pressure cuff connected to a
sphygmoma-nometer (sfig′mō-mă-nom′ĕ-ter) is wrapped around the patient’s arm,
and a stethoscope (steth′ ō-skōp) is placed over the brachial artery. The blood
pressure cuff is then inflated until the brachial artery is completely blocked. Because no
blood flows through the constricted area at this point, no sounds can be heard through
the stethoscope (figure 13.21, step 1). The pressure in the cuff is then gradually
lowered. As soon as the pressure in the cuff declines below the systolic pressure,
blood flows through the constricted area each time the left ventricle contracts. The
blood flow is turbulent immediately downstream from the constricted area. This
turbulence produces vibrations in the blood and surrounding tissues that can be heard
through the stethoscope. These sounds are called Korotkoff (Kō-rot′ kof) sounds, and
the pressure at which the first Korotkoff sound is heard is the systolic pressure.
As the pressure in the blood pressure cuff is lowered still more, the Korotkoff sounds
change tone and loudness. When the pressure has dropped until the brachial artery is
no longer constricted and blood flow is no longer turbulent, the sound disappears
completely. The pressure at which the Korotkoff sounds disappear is the diastolic
pressure. The brachial artery remains open during systole and diastole, and continuous
blood flow is re-established.
The systolic pressure is the maximum pressure produced in the large arteries. It is also
a good measure of the maximum pressure within the left ventricle. The diastolic
pressure is close to the lowest pressure within the large arteries. During relaxation of
the left ventricle, the aortic semilunar valve closes, trapping the blood that was ejected
during ventricular contraction in the aorta. The pressure in the ventricles falls to 0 mm
Hg during ventricular relaxation. However, the blood trapped in the elastic arteries is
compressed by the recoil of the elastic arteries, and the pressure falls more slowly,
reaching the diastolic pressure.

Pressure and resistance

The values for systolic and diastolic pressure vary among healthy people, making the
range of normal values quite broad. In addition, other factors, such as physical activity
and emotions, affect blood pressure values in a normal person. A standard blood
pressure for a resting young adult male is 120 mm Hg for the systolic pressure and 80
mm Hg for the diastolic pressure, commonly expressed as 120/80.
As blood flows from arteries through the capillaries and veins, blood pressure falls
progressively to about 0 mm Hg or even slightly lower by the time blood is returned to
the right atrium. In addition, the fluctuations in blood pressure are damped, meaning
that the difference between the systolic and diastolic pressures is decreased in the
small
diameter vessels. The decrease in fluctuations in pressure is the result of increased
resistance to blood flow in smaller and smaller vessels. By the time blood reaches the
capillaries, the smallest of the vessels, there is no variation in blood pressure, and only
a steady pressure of about 30 mm Hg remain.
Resistance to blood flow is related to the diameter of the blood vessel. The smaller the
diameter of the blood vessel, the greater the resistance to flow, and the more rapidly
the pressure decreases as blood flows through it. The most rapid decline in blood
pressure occurs in the arterioles and capillaries because their small diameters increase
the
resistance to blood flow. Blood pressure declines slowly as blood flows from large to
medium-sized arteries.
Because of veins’ large diameters, resistance to blood flow in them is low. The low
resistance results in low blood pressure in the veins. However, though pressure is low,
blood continues to flow through the veins toward the heart. Blood flow rate is ensured
and amplified by valves that prevent the backflow of blood in the veins, as well as
skeletal muscle movements that periodically compress veins, forcing blood to flow
toward the heart.
The muscular arteries, arterioles, and precapillary sphincters are capable of constricting
(vasoconstriction) and dilating (vasodilation). If vessels constrict, resistance to blood
flow increases, and the volume of blood flowing through the vessels declines. Because
muscular arteries can constrict and dilate, they help control the amount of blood flowing
to each region of the body. In contrast, arterioles and precapillary sphincters regulate
blood flow through local tissues.

Pulse Pressure
The difference between the systolic and diastolic pressures is called the pulse
pressure. For example, if a person has a systolic pressure of 120 mm Hg and a
diastolic pressure of 80 mm Hg, the pulse pressure is 40 mm Hg. Two factors affect
pulse pressure: stroke volume and vascular compliance. When the stroke volume
increases, the systolic pressure increases more than the diastolic pressure, causing
the pulse pressure to increase. During periods of exercise, the stroke volume and
pulse pressure increase substantially.
Vascular compliance is related to the elasticity of the blood vessel wall. In people who
have arteriosclerosis (ar-tēr′ ē-ō-skler-ō′ sis; hardening of the arteries), the arteries are
less elastic than normal. Arterial pressure increases rapidly and falls rapidly in these
fewer elastic arteries. The effect that this change has on blood pressure is that the
systolic pressure increases substantially, and the diastolic pressure may be somewhat
lower than normal or slightly increased. The same amount of blood ejected into a less
elastic artery results in a higher systolic pressure than it would have in a more elastic
artery. Therefore, the pulse pressure is greater than normal, even though the same
amount of blood is ejected into the aorta as in a normal person. Arteriosclerosis
increases the amount of work the heart performs because the left ventricle must
produce a greater pressure to eject the same amount of blood into a less elastic artery.
In severe cases, the heart’s increased workload leads to heart failure.
Ejection of blood from the left ventricle into the aorta produces a pressure wave, or
pulse, which travels rapidly along the arteries. A pulse can be felt at locations where
large arteries are close to the surface of the body. Health professionals should know the
major locations of pulse detection because monitoring the pulse can yield important
information about the heart rate, the heart rhythm, and other characteristics. For
example,
a weak pulse usually indicates a decreased stroke volume or increased constriction of
the arteries.

Capillary exchange
There are about 10 billion capillaries in the body. Nutrients diffuse across the capillary
walls into the interstitial spaces, and waste products diffuse in the opposite direction. In
addition, a small amount of fluid is forced out of the capillaries into the interstitial space
at their arterial ends. Most of that fluid, but not all, re-enters the capillaries at their
venous ends.
The major forces responsible for moving fluid through the capillary wall are blood
pressure and osmosis. Blood pressure forces fluid out of the capillary, and osmosis
moves fluid into the capillary. Fluid moves by osmosis from the interstitial space into the
capillary because blood has a greater osmotic pressure than does interstitial fluid. The
greater the concentration of molecules dissolved in a fluid, the greater the osmotic
pressure of the fluid. The greater osmotic pressure of blood is caused by the large
concentration of plasma proteins that are unable to cross the capillary wall. The
concentration of proteins in the interstitial space is much lower than that in the blood.
The capillary wall acts as a selectively permeable membrane, which prevents proteins
from moving from the capillary into the interstitial space but allows fluid to move across
the capillary wall.
At the arterial end of the capillary, the movement of fluid out of the capillary due to
blood pressure is greater than the movement of fluid into the capillary due to osmosis.
Consequently, there is a net movement of fluid out of the capillary into the interstitial
space.
At the venous end of the capillary, blood pressure is lower than at the arterial end
because of the resistance to blood flow through the capillary. Consequently, the
movement of fluid out of the capillary due to blood pressure is less than the movement
of fluid into the capillary due to osmosis, and there is a net movement of fluid from the
interstitial space into the capillary.
Approximately nine-tenths of the fluid that leaves the capillary at the arterial end re
enters the capillary at its venous end. The remaining one-tenth of the fluid enters the
lymphatic capillaries and is eventually returned to the general circulation.
Edema, or swelling, results from a disruption in the normal inwardly and outwardly
directed pressures across the capillary walls. For example, inflammation increases the
permeability of capillaries. Proteins, mainly albumin, leak out of the capillaries into the
interstitial spaces.
The proteins increase the osmotic pressure in the interstitial fluid. Consequently, fluid
passes from the arterial end of capillaries into the interstitial spaces at a greater rate,
and fluid passes from the interstitial spaces into the venous ends of capillaries at a
slower
rate. The lymphatic capillaries cannot carry all the fluid away. Thus, fluid accumulates
in the interstitial spaces, resulting in edema.

CONTROL OF BLOOD FLOW IN TISSUES

Blood flow provided to the tissues by the circulatory system is highly controlled and
matched closely to the metabolic needs of tissues. Mechanisms that control blood flow
through tissues are classified as (1) local control or (2) nervous and hormonal control.

Local Control Of Blood Flow

Local control of blood flow is achieved by the periodic relaxation and contraction of the
precapillary sphincters. When the sphincters relax, blood flow through the capillaries
increases. When the sphincters contract, blood flow through the capillaries decreases.
The precapillary sphincters are controlled by the metabolic needs of the tissues. For
example, blood flow increases when by-products of metabolism build-up in tissue
spaces.
During exercise, the metabolic needs of skeletal muscle increase dramatically, and the
by-products of metabolism are produced more rapidly. The precapillary sphincters
relax, increasing blood flow through the capillaries.
Other factors that control blood flow through the capillaries are the tissue
concentrations of O2 and nutrients, such as glucose, amino acids, and fatty acids
(figure 13.25 and table 13.1). Blood flow increases when O 2 levels decrease or, to a
lesser degree, when glucose, amino acids, fatty acids, and other nutrients decrease.
An increase in CO2 or a decrease in pH also causes the precapillary sphincters to
relax, thereby increasing blood flow.
In addition to the control of blood flow through existing capillaries, if the metabolic
activity of a tissue increases often, additional capillaries gradually grow into the area.
The additional capillaries allow local blood flow to increase to a level that matches the
metabolic needs of the tissue. For example, the density of capillaries in the well-trained
skeletal muscles of athletes is greater than that in skeletal muscles on a typical
nonathlete.

Nervous And Hormonal Control Of Blood Flow

Nervous control of blood flow is carried out primarily through the sympathetic division of
the autonomic nervous system. Sympathetic nerve fibers innervate most blood vessels
of the body, except the capillaries and precapillary sphincters, which have no nerve
supply.
An area of the lower pons and upper medulla oblongata, called the vasomotor center,
continually transmits a low frequency of action potentials to the sympathetic nerve
fibers. Therefore, the peripheral blood vessels are continually in a partially constricted
state, a condition called vasomotor (v̄a -s̄o - m̄o ′ ter) tone. An increase in vasomotor
tone causes blood vessels to constrict further and blood pressure to increase.
A decrease in vasomotor tone causes blood vessels to dilate and blood pressure to
decrease. Nervous control of blood vessel diameter is an impor-tant way that blood
pressure is regulated.
Nervous control of blood vessels also causes blood to be shunted from one large area
of the body to another. For example, nervous control of blood vessels during exercise
increases vasomotor tone in the viscera and skin and reduces vasomotor tone in
exercising skeletal muscles. As a result, blood flow to the viscera and skin decreases,
and blood flow to skeletal muscle increases. Nervous control of blood vessels during
exercise and dilation of precapillary sphincters as muscle activity increases together
increase blood flow through exercising skeletal muscle several-fold.
The sympathetic division also regulates hormonal control of blood flow through the
release of epinephrine and norepinephrine from the adrenal medulla. These hormones
are transported in the blood to all parts of the body. In most blood vessels, these
hormones cause constriction, which reduces blood flow. But in some tissues, such as
skeletal muscle and cardiac muscle, these hormones cause the blood vessels to dilate,
increasing blood flow.

REGULATION OF ARTERIAL PRESSURE

Adequate blood pressure is required to maintain blood flow through the blood vessels
of the body, and several regulatory mechanisms ensure that blood pressure remains
adequate for this task. The mean arterial blood pressure (MAP) is slightly less than
the average of the systolic and diastolic pressures in the aorta because diastole lasts
longer than systole. The mean arterial pressure is about 70 mm Hg at birth, is
maintained at about 95 mm Hg from adolescence to middle age and may reach 110
mm Hg in a healthy older person.
The body’s MAP is equal to the cardiac output (CO) times the peripheral resistance
(PR), which is the resistance to blood flow in all the blood vessels:

MAP = CO × PR
Because the cardiac output is equal to the heart rate (HR) times the stroke volume
(SV), the mean arterial pressure is equal to the heart rate times the stroke volume times
the peripheral resistance (PR):

MAP = HR × SV × PR
Thus, the MAP increases in response to increases in HR, SV, or PR, and the MAP
decreases in response to decreases in HR, SV, or PR. The MAP is controlled on a
minute-to-minute basis by changes in these variables. For example, when blood
pressure suddenly drops because of hemorrhage or some other cause, control systems
attempt to reestablish blood pressure by increasing HR, SV, and PR, so that blood
pressure is maintained at a value consistent with life. Mechanisms are also activated to
increase the blood volume to its normal value.
Baroreceptor reflexes
Baroreceptor reflexes activate responses that keep the blood pressure within its normal
range. Baroreceptors respond to stretch in arteries caused by increased pressure.
They are scattered along the walls of most of the large arteries of the neck and thorax,
and many are in the carotid sinus at the base of the internal carotid artery and in the
walls of the aortic arch. Action potentials travel from the baroreceptors to the medulla
oblongata along sensory nerve fibers
A sudden increase in blood pressure stretches the artery walls and increases action
potential frequency in the baroreceptors. The increased action potential frequency
delivered to the vasomotor and cardioregulatory centers in the medulla oblongata
causes responses that lower the blood pressure. One major response is a decrease in
vasomotor tone, resulting in dilation of blood vessels and decreased peripheral
resistance. Other responses, controlled by the cardioregulatory center, are an increase
in the parasympathetic stimulation of the heart, which decreases the heart rate, and a
decrease in the sympathetic stimulation of the heart, which reduces the stroke volume.
The decreased heart rate, stroke volume, and peripheral resistance lower the blood
pressure toward its normal value.
A sudden decrease in blood pressure results in a decreased action potential frequency
in the baroreceptors. The decreased frequency of action potentials delivered to the
vasomotor and cardioregulatory centers in the medulla oblongata produces responses
that raise blood pressure. Sympathetic stimulation of the heart increases, which
increases the heart rate and stroke volume. In addition, vasomotor tone increases,
resulting in constriction of blood vessels and increased peripheral resistance. The
increased heart rate, stroke volume, and peripheral resistance raise the blood pressure
toward its normal value.
These baroreceptor reflexes regulate blood pressure on a moment-to-moment basis.
When a person rises rapidly from a sitting or lying position, blood pressure in the neck
and thoracic regions drops dramatically due to the pull of gravity on the blood. This
reduction in blood pressure can be so great that it reduces blood flow to the brain
enough to cause dizziness or even loss of consciousness. The falling blood pressure
activates the baroreceptor reflexes, which reestablish normal blood pressure within a
few seconds.
A healthy person usually experiences only a temporary sensation of dizziness.

When O2 or pH levels decrease or when CO 2 levels increase, the chemoreceptors

respond with an increased frequency of action potentials and activate the
chemoreceptor reflexes (figure 13.29). In response, the vasomotor and
cardiovascular centers decrease parasympathetic stimulation of the heart, which
increases the heart rate. The vasomotor and cardioregulatory centers also increase
sympathetic stimulation of the heart, which further increases heart rate, stroke volume,
and vasomotor tone. All these changes result in increased blood pressure. This
increased blood pressure causes a greater rate of blood flow to the lungs, which helps
raise blood O2levels and reduce blood CO 2 levels. The chemoreceptor reflexes function
under emergency conditions and usually do not play an important role in regulating the
cardiovascular system. They respond strongly only when the O 2 levels in the blood fall
to very low levels or when CO2 levels become substantially elevated.
Hormonal Mechanisms
In addition to the rapidly acting baroreceptor and chemoreceptor reflexes, four
important hormonal mechanisms help control blood pressure.

Adrenal Medullary Mechanism

Stimuli that lead to increased sympathetic stimulation of the heart and blood vessels
also cause increased stimulation of the adrenal medulla. The adrenal medulla
responds by releasing epinephrine and small amounts of norepinephrine into the
blood. Epinephrine increases heart rate and stroke volume and causes
vasoconstriction, especially of blood vessels in the skin and viscera. Epinephrine also
causes vasodilation of blood vessels in skeletal muscle and cardiac muscle, thereby
increasing the supply of blood flowing to those muscles and preparing the body for
physical activity.

Renin-Angiotensin-Aldosterone Mechanism
In response to reduced blood flow, the kidneys release an enzyme called renin (rē′ nin)
into the circulatory system (figure 13.31). Renin acts on the blood protein
angiotensinogen (an′ jē-ō-ten-sin′ ō-jen) to produce angiotensin I (an-jē-ō-ten′ sin).
Another enzyme, called angiotensin-converting enzyme (ACE), found in large
amounts in organs, such as the lungs, acts on angiotensin I to convert it to its most
active form, angiotensin II. Angiotensin II is a potent vasoconstrictor. Thus, in
response to reduced blood pressure, the kidneys’ release of renin increases the blood
pressure toward its normal value.
Angiotensin II also acts on the adrenal cortex to increase the secretion of aldosterone
(al-dos′ ter-ōn). Aldosterone acts on the kidneys, causing them to conserve Na+ and
water. As a result, the volume of water lost from the blood into the urine is reduced.
The decrease in urine volume results in less fluid loss from the body, which maintains
blood volume. Adequate blood volume is essential to maintain normal venous return to
the heart and thereby maintain blood pressure.

Antidiuretic Hormone Mechanism

When the concentration of solutes in the plasma increases or when blood pressure
decreases substantially, nerve cells in the hypothalamus respond by causing the
release of antidiuretic (an′ tē-d̄ı - ̄u -ret′ ik; to decrease urine production) hormone
(ADH), also called vasopressin (v̄a-sō-pres′in; to cause vasoconstriction), from the
posterior pituitary gland (figure 13.32). ADH acts on the kidneys and causes them to
absorb more water, thereby decreasing urine volume. This response helps maintain
blood volume and blood pressure. The release of large amounts of ADH causes
vasoconstriction of blood vessels,
which causes blood pressure to increase.

Atrial Natriuretic Mechanism

A peptide hormone called atrial natriuretic (̄a ′ tr̄ e -̆a l n̄a ′ tr̄ e -̄u - ret′ ik) hormone is
released primarily from specialized cells of the right atrium in response to elevated
blood pressure. Atrial natriuretic hormone causes the kidneys to promote the loss of
Na+ and water in the urine, increasing urine volume. Loss of water in the urine causes
blood volume to decrease, thus decreasing the blood pressure.

summary of regulatory mechanisms

Blood pressure regulation involves both short-term and long-term mechanisms.
Baroreceptor mechanisms are most important in con-trolling blood pressure on a short
term basis.
They are sensitive to sudden changes in blood pressure, and they respond quickly. The
chemoreceptor and adrenal medullary reflexes are also sensitive to sudden changes in
blood pressure and respond quickly, but they respond to large changes in blood
pressure. The renin-angiotensin-aldosterone, antidiuretic hormone, and atrial natriuretic
mechanisms are more important in maintaining blood pressure on a long-term basis.
They are influenced by small changes in blood pressure or concentration and respond by
gradually bringing the blood pressure back into its normal range