Prevalence of Hypertension in a STEMI-activated Subset of Patients from 2019 to 2021

Background About 47% of United States adults have hypertension (HTN) per the 2017 Hypertension Clinical Practice Guidelines, where the blood pressure target is <130/90 mmHg. Prevalence is worse in certain distributions of the country with top quartile in the Southeastern pocket. In a subset of patients who present with ST-segment elevated myocardial infarction (STEMI), the prevalence is 30-40%. An interesting further subset of patients are those who presented as STEMI-alert during the COVID-19 pandemic. COVID-19 wreaked havoc on the world with its first confirmed case in 9 January 2020. International followed by national transport became limited, followed by announcement of a pandemic. Quarantines and lockdowns were set in place, especially in March 2020, to prevent epidemiologic spread. Hypothesis We were interested to observe if STEMI-alert patients during this period presented with worse background disease compared to years 2019 and 2021, years before and after COVID-lockdown and peak, including if the prevalence of background HTN increased in the population. Methods We evaluated 1001 adults who were STEMI-activated from 1 January 2019 to 31 December 2021 at five sites in Southwest Ohio. We obtained patient demographics and risk factors and performed multinomial logistic regression to compare years 2019 and 2021 to 2020. Statistical analysis was with SAS 9.4. Results For 1001 STEMI-alert patients, 244 patients (72.6%) had HTN in 2019, 250 (78.9%) in 2020 and 261 (75.0%) in 2021. Overall prevalence over the three years was 755 (75.4%). Compared to 2020, 2019 prevalence was not significant (p=0.12) (OR 0.72) (CI 0.47,1.09). Neither was 2021 (p=0.25) (OR 0.78) (CI 0.51,1.19). Conclusion STEMI-alert patients at our institution appeared to have higher overall prevalence of HTN than reported nationally by the Centers for Disease Control (CDC), 75.4% versus 47%. These may have self-selected for disease severity by STEMI-alert activation status. HTN may also be of higher prevalence in this region, be associated with poor disease detection or there may be patient compliance issues when antihypertensives are prescribed by a healthcare provider. HTN prevalence did not have statistical significance across the three observed years despite our hypothesis that patients would present with more background cardiac comorbidities such as HTN.