Intracranial hemorrhage in normotensive and hypertensive patients receiving streptokinase after decreasing elevated blood pressure

Many patients with suspected acute myocardial infarction (AMI) and eligible for thrombolyti c therapy may not be treated because of association between hemorrhagic complications especially intracranial hemorrhage (ICH), and severe hypertension (HTN) at presentation. Unfortunately, this leads to under use or delay in thrombolytic therapy. We assessed effect of decreasing elevated blood pre ssure before thrombolytic therapy in order to reduce the incidence of ICH without increasing mortality rate. Methods: This observational and analytical cohort study enrolled 293 patients (215males and 78 female) with STsegment elevation (AMI) that were hospitalized in emergency department of Noor hospital, Isfahan, Iran. Severe hypertension (blood pressure ~ 180111OmmHg) was diagnos ed in 132 patients. All of them received 1.5 million units streptokinase within one hour intravenously. In the hypertens ive group, elevated blood pressure was lowered to less than180111Ommhg before thrombolysi s and they were observed to detect development of symptoma tic ICH and they underwent Brain CT scan, if required. Results: The incidence of total stroke, ICH and death were 1.4%, 0.7% and 4.8%, respectiv ely. The incidence of death and ICH in patients with severe hypertension was less than control group (P value=0 .13 and 0.59, respectively ) Conclusion: Although we did not find any increase in ICH incidence in severe hypertensive patients treated be streptokinasedue to AMI, but we recommend a multi-centric study with more cases and varied thrombolyt ic protocols .