PREVALENCE OF UNDIAGNOSED HYPERTENSION IN PATIENTS PRESENTING WITH STROKE: A CROSS-SECTIONAL STUDY

Abstract

Stroke remains the leading cause of disability and death worldwide, with hypertension (HTN) identified as the most modifiable risk factor. Undiagnosed HTN frequently goes undetected until it causes a stroke, especially in resource-constrained settings. The purpose of this descriptive cross-sectional study was to determine the prevalence of undiagnosed HTN among patients presenting with acute stroke to the Department of Neurology, Nishtar Hospital Multan. Following ethics committee approval and informed consent, 176 consecutive patients aged 35-65 years with new-onset ischemic or hemorrhagic stroke were enrolled for six months (September 2024-March 2025). Within one hour of admission, blood pressure (BP) was measured using standard mercury sphygmomanometry (≥140/90 mmHg defining HTN), with three 30-minute intervals. Sociodemographic information and vascular risk factors (diabetes mellitus, obesity, smoking) were collected. The WHO single-proportion formula was used to calculate the sample size, which was 176 participants based on a background HTN prevalence of 33.7%, precision of 7%, and 95% confidence level. SPSS v.23.0 was used for data analysis, with continuous variables reported as mean ± SD or median (IQR), categorical variables as frequencies, and stratified analyses using χ² tests (p ≤ 0.05 significant). Among 176 patients (mean age 54.3 ± 8.7 years; 62.5% male), 108 (61.4%) had HTN at admission, while 58 (33.0%) were new, undiagnosed cases. Undiagnosed hypertension was significantly higher among patients aged ≥55 years (p = 0.02) and those with ischemic stroke (p = 0.01). Table 1 shows baseline characteristics; Figure 1 depicts the distribution of HTN status; and Figure 2 shows the prevalence of major risk factors. These findings highlight the critical importance of implementing systematic blood pressure screening programs in Pakistan to reduce the stroke burden.