EFFECT OF HYDROCORTISONE ON STREPTOKINASE-INDUCED HYPOTENSION IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

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 p ressure during streptokinase infusion in patients with acute myocardia l 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 all ocated 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 x 10(6) IU streptokinase over one hou r. Systemic blood pressure was measured with a manual sphygmomanometer at least 5 min before the commencement, during and 60 min after the e nd of streptokinase infusion. Difference in blood pressure before, and the lowest blood pressure during, infusion was then recorded as maxim al fall in blood pressure. Results: A maximal fall in systolic blood p ressure (SEP) during infusion was significantly lower in the treated g roup (28 +/- 23 (SD) vs 34 +/- 24 mm Hg; P=0.046). There was no signif icant difference in maximal fall in diastolic blood pressure between t he two groups. In a small group of patients who were hypotensive befor e SK infusion (SBP < 100 mm Hg), fall in systolic and diastolic blood pressure seems to be effectively prevented. However, the difference be tween these subgroups are inconclusive owing to there being too small a number for statistical analysis. Conclusion: We conclude that hydroc ortisone diminishes a maximal fall in systolic blood pressure during s treptokinase infusion in patients with acute myocardial infarction, bu t 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 p atients.