Objective: To characterize the impact of hypertensi-on on a ST elevation myocardial infarction (STEMI) population. We studied, both subclinical and clinical changes.

Methods: We reviewed a nationwide STEMI registry. 2018 data from a geographical region of a national STEMI registry were analyzed. In-hospital medical no-tes from 3800 patients admitted with STEMI in the pri-mary PCI network hospitals were evaluated.

Results: We selected the patients with history of hyper-tension at the moment of acute coronary syndrome diagnosis. Among those 3800 patients analyzed, 2708 (70.9%) had diagnosis of hypertension prior to STEMI. The hypertensive STEMI patients had extensive coro-nary involvement defined as multivessel disease (31.6 vs. 11.6%, p<0.005). Among cardiovascular risk fac-tors, the incidence of diabetes mellitus (DM) was three times higher in the hypertensive group (31.2 vs. 11.6%, p<0.005); renal impairment and lower hemoglobin le-vels were noted in this group. Despite the extensive co-ronary damage, the clinical picture at admission in the hypertensive cohort was less severe, with fewer acute heart failure cases (class Killip 3 and 4) (9.3 vs. 13.6%, p<0.005) and lower death rate (5.9 vs.7.7%, p<0.044). The overall death rate in the STEMI cohort was 6.9%, similar to other European ACS cohorts.

Conclusions: Though more severe in terms of multiple vessel involvement and cardiac risk factors, the evoluti-on of the hypertensive patients was better probably due to the antihypertensive previous treatment. A thorough evaluation of the hypertension duration as well as the type of treatment used might better characterize this cohort