In addition to the baroreceptor reflex, several other reflexes help to regulate blood pressure. The reflex control of ADH release by osmoreceptors in the hypothalamus and the control of an-giotensin II production and aldosterone secretion by the juxta-
glomerular apparatus of the kidneys have been previously discussed. Antidiuretic hormone and aldosterone increase blood pressure by increasing blood volume, and angiotensin II stimulates vasoconstriction to cause an increase in blood pressure.
Other reflexes important to blood pressure regulation are initiated by atrial stretch receptors located in the atria of the heart. These receptors are activated by increased venous return to the heart and, in response (1) stimulate reflex tachycardia, as a result of increased sympathetic nerve activity; (2) inhibit ADH release, resulting in the excretion of larger volumes of urine and a lowering of blood volume; and (3) promote increased secretion of atrial natriuretic peptide (ANP). The ANP, as previously discussed, lowers blood volume by increasing urinary salt and water excretion and by antagonizing the actions of angiotensin II.
Valsalva's maneuver is the term used to describe an expiratory effort against a closed glottis (which prevents the air from escaping—see chapter 16). This maneuver, commonly performed during forceful defecation or when lifting heavy weights, increases the intrathoracic pressure. Compression of the thoracic veins causes a fall in venous return and cardiac output, thus lowering arterial blood pressure. The lowering of arterial pressure then stimulates the baroreceptor reflex, resulting in tachycardia and increased total peripheral resistance. When the glottis is finally opened and the air is exhaled, the cardiac output returns to normal. The total peripheral resistance is still elevated, however, causing a rise in blood pressure. The blood pressure is then brought back to normal by the baroreceptor reflex, which causes a slowing of the heart rate. These fluctuations in cardiac output and blood pressure can be dangerous in people with cardiovascular disease. Even healthy people are advised to exhale normally when lifting weights.
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