Awareness of Stroke Warning Signs and Risk Factors Among Patients with Hypertension and Diabetes Mellitus at a Tertiary-Care Hospital in Quetta, Pakistan: A Cross-Sectional Study

Abstract

Background: Stroke remains a major cause of death, disability, and long-term functional dependence, particularly in populations with modifiable vascular risk factors such as hypertension and diabetes mellitus. Objective: To assess awareness of stroke warning signs and risk factors among patients with hypertension and/or type 2 diabetes mellitus attending a tertiary-care hospital in Quetta, Pakistan, and to identify factors associated with overall stroke awareness. Methods: This cross-sectional study was conducted from July to December 2025. Using convenience sampling, 210 consenting adults with hypertension, type 2 diabetes mellitus, or both were enrolled. Awareness was assessed using 10 warning-sign and 12 risk-factor items. Composite awareness scores were analyzed using descriptive statistics, group comparisons, correlation analysis, and multiple linear regression in IBM SPSS Statistics version 26.0. Results: Mean age was 55.54 ± 11.86 years. Mean warning-sign awareness was 40.90 ± 19.60%, risk-factor awareness was 48.89 ± 15.85%, and composite awareness was 44.90 ± 14.34%. Only 23.8% had good overall awareness. Unilateral weakness (58.1%) and speech difficulty (51.9%) were the best-recognized warning signs, while hypertension (79.5%) was the best-recognized risk factor. Although 86.2% intended to seek hospital care, only 24.8% would call an ambulance. Increasing age independently predicted lower awareness, whereas urban residence, higher educational attainment, and knowing someone with stroke were associated with greater awareness. Conclusion: Stroke awareness was suboptimal despite established vascular risk. Routine hypertension and diabetes care should integrate targeted education that emphasizes acute warning signs, ambulance activation, and groups with lower awareness, particularly older, rural, and less-educated patients. Keywords: Stroke; Awareness; Warning Signs; Risk Factors; Hypertension; Diabetes Mellitus; Quetta; Pakistan.