Effect of hydrocortisone on streptokinase-induced hypotension in patients with acute myocardial infarction

Abstract

Summary Objective: A fall in blood pressure frequently occurs during infusion of streptokinase in patients with acute myocardial infarction. In the present study, we investigated the effect of hydrocortisone on blood pressure during streptokinase infusion in patients with acute myocardial infarction. Design and subjects: A double blind, placebo-controlled study was performed. We included 182 consecutive patients treated for acute myocardial infarction. Interventions: Patients were randomly allocated to receive an intravenous injection of 100 mg hydrocortisone (n=91, treated group) or an equal volume of saline (n=91, control group) before the commencement of streptokinase infusion. They were treated with intravenous infusion of 1.5 × 106 IU streptokinase over one hour. Systemic blood pressure was measured with a manual sphygmomanometer at least 5 min before the commencement, during and 60 min after the end of streptokinase infusion. Difference in blood pressure before, and the lowest blood pressure during, infusion was then recorded as maximal fall in blood pressure. Results: A maximal fall in systolic blood pressure (SBP) during infusion was significantly lower in the treated group (28 ± 23 (SD) vs 34 ± 24 mm Hg; P = 0.046). There was no significant difference in maximal fall in diastolic blood pressure between the two groups. In a small group of patients who were hypotensive before SK infusion (SBP Conclusion: We conclude that hydrocortisone diminishes a maximal fall in systolic blood pressure during streptokinase infusion in patients with acute myocardial infarction, but has no effect on a fall in diastolic blood pressure. In hypotensive patients the effect of hydrocortisone seems to be even more pronounced but our results are inconclusive owing to the small number of these patients.