Awareness Of Stroke Warning Signs And Risk Factors Among Patients With Hypertension And Diabetes Mellitus At A Tertiary-Care Hospital In Lahore, Pakistan: A Cross-Sectional Study
DOI:
https://doi.org/10.61919/jhrr.v6i6.2016Keywords:
Stroke awareness; warning signs; risk factors; hypertension; diabetes mellitus; Pakistan; cross-sectional study.Abstract
Background: Stroke is a major cause of mortality and long-term disability, particularly in low- and middle-income countries where delayed recognition of warning signs and inadequate control of modifiable risk factors contribute to poor outcomes. Patients with hypertension and diabetes mellitus are at increased cerebrovascular risk and represent an important target group for preventive education. Objective: To assess awareness of stroke warning signs and risk factors among patients with hypertension, diabetes mellitus, or both attending tertiary-care outpatient services at Mayo Hospital, Lahore, Pakistan. Methods: This hospital-based descriptive cross-sectional study included 281 participants recruited from the Medicine Outpatient Department, Neurology Outpatient Department, and Diabetic Clinic. Stroke awareness was assessed using a structured questionnaire covering recognition of warning signs, risk factors, and overall knowledge categories. Data were summarized as frequencies and percentages. Results: Most participants recognized that stroke affects the brain (267/281, 94.9%), and 225 participants (80.1%) were aware of FAST symptoms. Sudden weakness was recognized by 208 participants (74.0%), whereas awareness of vision problems and altered consciousness was low, reported by 81 (29.0%) and 21 (7.6%) participants, respectively. Smoking, hypertension, and diabetes mellitus were identified as risk factors by 204 (72.6%), 197 (70.0%), and 195 (69.3%) participants, respectively. Adequate overall risk-factor knowledge was present in 129 participants (45.8%). Conclusion: Stroke awareness among high-risk outpatients was partial and uneven, with substantial gaps in recognition of non-motor warning signs and comprehensive risk knowledge. Structured stroke-education strategies should be integrated into outpatient hypertension and diabetes care.
Downloads
References
Mumtaz A, Akram J, Hasan AH, Ali R, Tariq MS, Tauqeer A, et al. Assessment of the awareness of warning signs and risk factors of stroke in a tertiary care hospital of Rawalpindi: a descriptive cross-sectional study. American Journal of Health, Medicine and Nursing Practice. 2023;8(1):13-19. doi:10.47672/ajhmn.1342.
Ananchaisarp T, Sa-a K. Knowledge of stroke and planned response among patients living with diabetes mellitus and hypertension in a primary care unit. Siriraj Medical Journal. 2022. doi:10.33192/smj.2022.10.
Maniatunufus, Nursiswati. Risk factors and stroke symptoms knowledge among diabetes mellitus, hypertension and heart disease patients: literature review. Journal of Diabetes Research Reviews & Reports. 2024. doi:10.47363/jdrr/2024(6)177.
Alkhalifah KM, Al Hunaif AM, Alghamdi BS, Alqhatani RS, Almanea DM, Alshahrani AA, et al. Awareness of stroke risk factors and warning signs among diabetic patients in the Aseer Region, Saudi Arabia: a cross-sectional study. Cureus. 2023. doi:10.7759/cureus.42562.
Melak AD, Wondimsigegn D, Kifle ZD. Knowledge, prevention practice and associated factors of stroke among hypertensive and diabetic patients: a systematic review. Risk Management and Healthcare Policy. 2021. doi:10.2147/RMHP.S324960.
Elshebiny A, Almuhanna M, AlRamadan M, Aldawood M, Aljomeah Z. Awareness of stroke risk factors, warning signs, and preventive behaviour among diabetic patients in Al-Ahsa, Saudi Arabia. Cureus. 2023. doi:10.7759/cureus.35337.
Haider I, Badshah A, Rahman S, Ullah M, Fayyaz M, Mohammad W. Risk factors for hypertension in patients with stroke presenting to tertiary care hospital. Journal of Gandhara Medical and Dental Science. 2023. doi:10.37762/jgmds.10-4.469.
Rupasinghe CD, Bokhari SA, Lutfi I, Noureen M, Islam F, Khan M, et al. Frequency of stroke and factors associated with it among old age hypertensive patients in Karachi, Pakistan: a cross-sectional study. Cureus. 2022. doi:10.7759/cureus.23123.
Sherin A, Ul-Haq Z, Fazid S, Shah B, Khattak MI, Nabi F. Prevalence of stroke in Pakistan: findings from Khyber Pakhtunkhwa Integrated Population Health Survey (KP-IPHS) 2016-17. Pakistan Journal of Medical Sciences. 2020. doi:10.12669/pjms.36.7.2824.
Malik A, Khan M, Zehra F, Wasay M, Khan RN, Aisha. Potential risk factors of stroke: a community-based, cross-sectional study from Sindh Province of Pakistan. Khyber Medical University Journal. 2020. doi:10.35845/kmuj.2020.19702.
Mali Y, Chilapur VG, Natekar DS, Holdur R, Gavari DN. A study was conducted to evaluate the risk factors associated with stroke among hypertensive patients receiving care at the Medical Outpatient Department (OPD) of HSK Hospital & Research Centre in Navanagar, Bagalkot. International Journal of Innovative Science and Research Technology. 2024. doi:10.38124/ijisrt/ijisrt24mar025.
Syed W, Qadhi O, Barasheed A, Alzahrani E, Al-Rawi MBA. Evaluation of knowledge of risk factors and warning signs of stroke: an observational study among future health care professionals. Frontiers in Public Health. 2023. doi:10.3389/fpubh.2023.1131110.
Farooq A, Essa M, Saleem M, Aleem A, Rizwan M. Evaluation of stroke awareness and risk factor prevalence among students at a public sector university in Quetta. Pakistan Journal of Neurological Sciences. 2024. doi:10.56310/pjns.v18i04.322.
Workina A, Kebede S, Fekadu C, Snr AW. Knowledge of risk factors and warning signs of stroke among patients with heart disease at Tikur Anbessa Specialized Hospital. Open Access Emergency Medicine. 2021. doi:10.2147/OAEM.S291648.
Setyopranoto I, Upoyo AS, Isworo A, Sari Y, Vidyanti AN. Awareness of being at risk of stroke and its determinant factors among hypertensive patients in Banyumas, Indonesia. Stroke Research and Treatment. 2022;2022:1-7. doi:10.1155/2022/4891134.
Amir A, Hassan M, Alvi S, Mueed A, Idrees S, Ashraf J, et al. Frequency and characteristics of metabolic syndrome in patients with ischemic stroke admitted to a tertiary care hospital in Karachi. Cureus. 2020. doi:10.7759/cureus.9004.
Sirisha S, Jala S, Vooturi S, Yada P, Kaul S. Awareness, recognition, and response to stroke among the general public: an observational study. Journal of Neurosciences in Rural Practice. 2021. doi:10.1055/s-0041-1735822.
Soto-Cámara R, González-Bernal JJ, González-Santos J, Aguilar-Parra JM, Trigueros R, López-Liria R. Knowledge on signs and risk factors in stroke patients. Journal of Clinical Medicine. 2020;9(8):2557. doi:10.3390/jcm9082557.
Getu RA, Aga F, Badada T, Workie SG, Belew MA, Mekonnen RNK. Knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes in Addis Ababa, Ethiopia, 2021: an institution-based cross-sectional study. BMC Cardiovascular Disorders. 2023. doi:10.1186/s12872-022-03031-8.
Alsaadon H, Afroz A, Karim A, Habib S, Alramadan MJ, Billah B, et al. Hypertension and its related factors among patients with type 2 diabetes mellitus: a multi-hospital study in Bangladesh. BMC Public Health. 2022. doi:10.1186/s12889-022-12509-1.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Khadija Usman

This work is licensed under a Creative Commons Attribution 4.0 International License.
Public Licensing Terms
This work is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). Under this license:
- You are free to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material) for any purpose, including commercial use.
- Attribution must be given to the original author(s) and source in a manner that is reasonable and does not imply endorsement. If changes were made to the material, this must be indicated.
- No additional restrictions may be applied that conflict with the terms of this license.
For more details, visit: https://creativecommons.org/licenses/by/4.0/