J Gandhara Med Dent Sci

April - June 2026

ORIGINAL ARTICLE

FREQUENCY OF HYPERTENSION IN PATIENTS WITH ISCHAEMIC AND HAEMORRHAGIC

STROKE PRESENTING AT HAYATABAD MEDICAL COMPLEX

Muhammad Bilal

, Muhammad Ishfaq

, Muhammad Usman Khattak

, Sadiq Ali Shah

, Saullah

, Abdul Wahab

ABSTRACT

OBJECTIVES

This study aimed to determine the frequency of hypertension and its

association with stroke subtype (ischaemic and haemorrhagic) among

patients presenting with stroke at Hayatabad Medical Complex.

METHODOLOGY

This cross-sectional study was conducted from June to December 2024 at the

Department of Medicine, Hayatabad Medical Complex, Peshawar. All

patients presenting with either ischemic or hemorrhagic stroke were

included. Data were collected on hypertension status, obesity, ICU

admission, and adherence to antihypertensive medication. Descriptive

statistics were used to summarize patient characteristics, and associations

between stroke subtypes and selected variables were explored.

RESULTS

Among 220 stroke patients, the mean age was 58.35 ± 13.78 years, with a

median age of 60 years (IQR: 50–69). The mean BMI was 27.54 ± 5.24 kg/m²,

and the median length of hospital stay was 4 days (IQR: 2–6). Ischaemic

stroke accounted for 69.1% of cases, while 30.9% had haemorrhagic stroke.

Hypertension was present in 75% of patients. There was a signicant

association between hypertension and stroke type (χ² = 30.91, p < 0.001),

with hypertensive patients more frequently experiencing ischaemic stroke. In

bivariate logistic regression analysis, hypertension, age category, and

medication adherence were signicantly associated with stroke type. After

adjustment in the multivariable logistic regression model, hypertension (AOR

= 0.15, p < 0.001), age category (AOR = 0.24, p < 0.001), and medication

adherence (AOR = 0.49, p = 0.046) remained signicant predictors. The

Hosmer–Lemeshow test demonstrates good calibration and adequate t to

the data.

CONCLUSION

Hypertension was highly prevalent among patients with both ischemic and

hemorrhagic stroke in this study population, highlighting its importance as a

major modiable risk factor. Strengthening hypertension screening and

control programs may help reduce the burden of stroke.

KEYWORDS: Ischemic Stroke, Hemorrhagic Stroke, Hypertension

How to cite this article

Bilal M, Ishfaq M, Khattak MU, Shah

SA, Saullah, Wahab A. Frequency of

Hypertension In Patients with

Ischaemic and Haemorrhagic Stroke

Presenting at Hayatabad Medical

Complex. J Gandhara Med Dent Sci.

2026;13(2):34-39

Date of Submission: 22-10-2025

Date Revised: 08-03-2026

Date Acceptance: 10-03-2026

Postgraduate Trainee, Department of

Medicine, Hayatabad Medical

Complex, Peshawar

Associate Professor, Department of

Medicine, Hayatabad Medical

Complex, Peshawar

Correspondence

Muhammad Ishfaq, Associate

, Department of Medicine,Professor

Hayatabad Medical Complex,

Peshawar

+92-333-9005472

dashfaq@gmail.com

INTRODUCTION

A cerebrovascular accident, often known as a brain

stroke, is a medical emergency that requires rapid

attention to prevent long-term damage or, in severe

cases, death. It not only imposes a nancial burden on

the aected individual but also on family members.

Most patients who experience a stroke present with

focal neurological decits resulting from damage to

specific brain regions where blood ow has been

interrupted by a clot, leading to loss of function in the

affected areas.

2,3

Cerebrovascular accident is one of the

leading causes of death in developed countries and the

second leading cause of death globally.

According to a

study of 105 stroke patients, hyperlipidaemia was the

most common risk factor (50.5%) in patients with

ischaemic stroke, followed by smoking (40.9%),

hypertension (39.1%), and diabetes mellitus (39.1%).⁵

Stroke is a common complication of hypertension and

may occur due to either cerebral infarction or

intracerebral hemorrhage. Patients with hypertension

have a higher prevalence of carotid atherosclerosis and

are more likely to experience transient ischemic attacks

(TIAs). Hypertension is therefore considered a major

risk factor for both ischemic and hemorrhagic stroke.

Several modiable and non-modifiable risk factors

contribute to the development of cerebrovascular

accidents. Well-established non-modifiable risk factors

https://doi.org/10.37762/jgmds.13-2.810

J Gandhara Med Dent Sci

April - June 2026

include increasing age, sex, race, family history of

stroke, and ethnic background.

7,8

In contrast, modiable

risk factors are those that can be controlled or treated;

effective management of these factors can signicantly

reduce stroke risk.

A previous study reported that

59.5% of patients with ischemic and hemorrhagic

stroke had hypertension.

Hypertension is characterized

by persistently elevated blood pressure and is a well-

established major risk factor for both ischemic and

hemorrhagic stroke. The burden of hypertension among

stroke patients is considerable and contributes

significantly to stroke-related morbidity and mortality

worldwide. Understanding the distribution of

hypertension among patients with dierent types of

stroke is important for improving preventive strategies

and clinical management. Due to the limited local data

on this topic, the present study aims to determine the

frequency of hypertension in patients with ischemic and

hemorrhagic stroke presenting to Hayatabad Medical

Complex, Peshawar. Assessing the prevalence of

hypertension among stroke patients may help inform

local healthcare strategies aimed at early detection and

improved management of hypertension to reduce the

burden of stroke. Furthermore, distinguishing between

ischemic and hemorrhagic stroke is important for

accurate diagnosis and appropriate management, as

these conditions dier in their pathophysiology, clinical

features, and treatment approaches.

METHODOLOGY

This was a cross-sectional hospital-based study

conducted at the Department of Medicine, Hayatabad

Medical Complex, Peshawar, from June 2024 to

December 2024. The objective of the study was to

assess the frequency of hypertension among patients

who present with ischaemic and haemorrhagic stroke

and to find the association of hypertension with the type

of stroke. All adult patients aged 18 years or older who

were diagnosed clinically and/or radiologically with

ischemic or hemorrhagic stroke were included in the

study. Information regarding hypertension status was

obtained from the patient‘s medical history, previous

medical records, or current use of antihypertensive

medication. Both patients with and without

hypertension were included to determine the frequency

of hypertension among stroke patients. Patients with

transient ischaemic attack and those with illnesses that

mimic strokes were excluded from the study. The

sample size was calculated using the OpenEpi

calculator for a single-proportion sample. This

calculation was based on the prevalence of

hypertension of 59.9 % among patients of stroke as

reported by a study of Fatima et al.

A condence

interval of 95 % and a margin of error of 6.5% were

assumed. Based on these parameters, the sample size

was 220. Consecutive non-probability sampling was

used for all patients who presented during the study

period. Data collection began after ethical approval

from the hospital research ethics board (no. 1851, dated

11th May 2024) and the department of research, CPSP.

All patients who met the selection criteria were

provided with information on the purpose and benet of

the study. All participants signed an informed consent

form. Demographic details such as age, gender, weight,

BMI, education status, socioeconomic status based on

income, and area of residence were documented.

Patients presenting with ischemic or hemorrhagic stroke

were assessed for hypertension. Blood pressure was

measured on admission using a standard calibrated

sphygmomanometer with the patient in the sitting

position after at least 5 minutes of rest. Two blood

pressure readings were taken 5 minutes apart, and the

average of the two was recorded. Hypertension was

defined as a systolic blood pressure ≥140 mmHg and/or

diastolic blood pressure ≥90 mmHg, or a prior

documented diagnosis of hypertension or current use of

antihypertensive medication. The entire assessment was

performed under the supervision of a consultant. A pro

forma was used to record each patient’s details.

Information regarding types of strokes, hypertension

status, medication adherence, ICU admission, economic

status on an income basis, and BMI was also recorded.

Data was analysed using SPSS Version 25. Mean ± SD

and median with IQR were reported for continuous

variables such as age, BMI, and length of stay.

Frequencies and percentages are-reported for

categorical variables, including gender, hypertension,

education status, socioeconomic status, area of

residence, and type of stroke. To test whether the

proportion of hypertensive patients diers between

ischaemic and haemorrhagic stroke, we analyse the data

using the chi-square test. Binary logistic regression was

performed to determine factors associated with stroke

type (ischaemic vs haemorrhagic). Stroke type was

entered as the dependent variable, while hypertension,

age category, sex, BMI category, ICU admission, and

medication adherence were included as independent

variables. Both bivariate and multivariate analyses were

carried out. Odds ratio was calculated for hypertension

among ischaemic and haemorrhagic stroke with a 95%

confidence interval. A p-value of less than 0.05 was

taken as signicant. The predictor model was assessed

for calibration using the Hosmer-Lemeshow test, and

for discrimination between hypertensive and non-

hypertensive patients, the ROC curve and area under

the curve were calculated.

RESULTS

A total of 220 stroke patients were included in the

Frequency of Hypertension in Patients with Ischaemic

J Gandhara Med Dent Sci

April - June 2026

study. The mean age was 58.35 ± 13.78 years, and the

median was 60 (IQR=19). Mean BMI was 27.54. Table

1 shows frequencies of categorical variables. Obesity

was dened as BMI ≥ 30 kg/m². Table 2 shows the

cross-tabulation of hypertension by stroke type. The

association is highly signicant (p-value < 0.001). This

means that hypertension is much more common in

patients with ischaemic stroke. Binary logistic

regression was performed to assess the association

between stroke type and hypertension, age, obesity,

ICU admission, and medication adherence.

Table 1: Sociodemographic and Clinical Characteristics of

Participants (n = 220)

Variable Category Frequency %age

Sex

Male 113 51.4

Female 107 48.6

Area of

Residence

Rural 120 54.5

Urban 100 45.5

Educational

Status

Uneducated 130 59.1

Educated 90 40.9

Type of Stroke

Ischaemic 152 69.1

Haemorrhagi

68 30.9

Socioeconomic

Status

Low 112 50.9

Middle 80 36.4

High 28 12.7

Hypertensive

Status

Hypertensive 165 75

Non-

Hypertensive

55 25

Medication

Adherence

Adherence to

Medication

118 53.6

Non-

Adherence

102 46.4

ICU Admission

No 171 77.7

Yes 49 22.3

Age Category

Age ≥ 50

years

151 68.6

Age < 50

years

69 31.4

Obesity Category

Non-Obese 162 73.6

Obese 58 26.4

Table 2: Association between Hypertension and Stroke Type

Non-

Hypertensive

Chi-

Square

P-

Value

Ischemic

Stoke

21 (14%) 131 (86%)

<0.001

Hemorrhagic

Stroke

34 (50 %) 34 (50 %)

30.91

Table 3: Bivariate Logistic Regression for Factors Associated

with Stroke Type

Variable Crude OR 95% CI P-Value

Hypertension 0.16 0.08 – 0.31 <0.001

Age category 0.20 0.11 – 0.38 <0.001

Gender 1.19 0.67 – 2.12 0.545

BMI category 0.64 0.32 – 1.26 0.195

ICU admission 0.50 0.23 – 1.07 0.074

Medication

adherence

0.53 0.30 – 0.94 0.029

Table 4: Multivariate Logistic Regression Analysis for Factors

Associated with Stroke Type

Variable Adjusted OR 95% CI P-Value

Hypertension 0.15 0.07 – 0.32 <0.001

Age category 0.24 0.12 – 0.49 <0.001

Gender 1.78 0.88 – 3.58 0.108

BMI category 0.86 0.38 – 1.94 0.718

ICU/HDU

admission

0.46 0.19 – 1.14 0.093

Medication

adherence

0.49 0.24 – 0.99 0.046

Table 5: Hosmer-Lemeshow Goodness -of -Fit Test

Statistic Value

Hosmer-Lemeshow χ² 5.11

Degrees of Freedom 08

P-Value 0.746

Figure 1: ROC Curve for Stroke Prediction Model

DISCUSSION

In the present study conducted among 220 stroke

patients, hypertension emerged as a highly prevalent

comorbidity, aecting 75% of the participants.

Furthermore, ischaemic stroke constituted the majority

of cases (69.1%), while haemorrhagic stroke accounted

for 30.9%. Multivariable logistic regression analysis

demonstrated that hypertension, age category, and

medication adherence were independent predictors of

stroke type, whereas gender, BMI category, and ICU

admission were not signicantly associated after

adjustment. These ndings highlight the central role of

hypertension in the pathogenesis of stroke in this

population. Our analysis demonstrated that

hypertension was signicantly associated with stroke

type. Patients with ischaemic stroke had substantially

higher odds of being hypertensive compared with those

with haemorrhagic stroke. In the adjusted model,

hypertension remained a strong predictor (AOR = 0.15,

95% CI: 0.07-0.32, p < 0.001). This nding supports

the well-established role of hypertension as a major

Frequency of Hypertension in Patients with Ischaemic

J Gandhara Med Dent Sci

April - June 2026

modifiable risk factor for stroke. Large population-

based studies have consistently reported that

hypertension signicantly increases the risk of both

ischaemic and haemorrhagic strokes. One such study

reported that untreated hypertension increases the odds

of intracerebral haemorrhage by nearly threefold (OR =

3.5), while even treated hypertension still increases the

likelihood of haemorrhage by 1.4 times.¹¹ Similarly,

hypertension has been reported to be associated with

spontaneous intracerebral haemorrhage in

approximately 80% of cases, and it is linked with

poorer clinical outcomes.

12,13

Furthermore, global

epidemiological data indicate that uncontrolled

hypertension remains the most signicant modiable

risk factor responsible for nearly half of all stroke cases

worldwide.

14,15,16

Although hypertension is strongly

associated with haemorrhagic stroke in the literature,

our study observed a higher prevalence of hypertension

among patients with ischaemic stroke. This discrepancy

may reect regional dierences in blood pressure

control and healthcare access. In many low- and

middle-income settings, including Pakistan, long-

standing uncontrolled hypertension may contribute to

progressive vascular damage, atherosclerosis, and

ultimately ischaemic cerebrovascular events. Therefore,

the higher proportion of hypertensive patients among

ischaemic stroke cases in our study may reflect the

burden of chronic uncontrolled hypertension in the

local population. Our ndings are consistent with

previous hospital-based studies conducted in similar

settings. Abdu et al. reported that hypertension was

present in 39.8% of patients with ischaemic stroke and

23.4% of those with haemorrhagic stroke.¹³ This pattern

supports the observation that hypertension is frequently

encountered in patients with ischaemic stroke in clinical

practice. Similarly, a study conducted in Pakistan

reported that ischaemic stroke was more prevalent than

haemorrhagic stroke among hypertensive patients.¹⁴

These ndings collectively suggest that the interaction

between hypertension and stroke subtype may vary

across populations depending on demographic

characteristics, healthcare access, and blood pressure

management strategies. Age was another signicant

predictor identied in our analysis. Patients aged ≥60

years had higher odds of experiencing ischaemic stroke,

with the association remaining signicant after

adjustment (AOR = 0.24, 95% CI: 0.12-0.49, p <

0.001). This observation aligns with the well-

established relationship between advancing age and

increased risk of cerebrovascular disease. Aging is

associated with progressive vascular changes, including

arterial stiffness, endothelial dysfunction, and

accumulation of atherosclerotic plaques, all of which

predispose individuals to ischaemic stroke. A large

cohort study reported that Akhtar et al. similarly

reported that individuals aged >60 years had

signicantly higher odds of developing ischaemic

stroke (adjusted OR = 1.68; 95% CI: 1.05–2.68).¹⁵

Additionally, international epidemiological studies have

shown that the incidence of stroke increases

exponentially after the age of 55 years, doubling with

each subsequent decade of life.¹⁷ Medication adherence

also demonstrated a statistically signicant association

with stroke type in the multivariable model (AOR =

0.49, 95% CI: 0.24-0.99, p = 0.046). Poor adherence to

antihypertensive therapy is a well-recognized

contributor to uncontrolled blood pressure, which may

accelerate vascular damage and increase the risk of

cerebrovascular events. Previous studies have similarly

demonstrated that poor adherence to antihypertensive

medications signicantly increases the risk of stroke

recurrence and adverse cardiovascular outcomes.¹⁸ This

finding emphasizes the importance of improving

medication adherence as part of comprehensive stroke

prevention strategies. In contrast, BMI category,

gender, and ICU/HDU admission were not significantly

associated with stroke type after adjustment for other

variables. The lack of association with ICU admission

suggests that the severity of stroke requiring intensive

care may depend on several other clinical factors, such

as infarct size, hemorrhage volume, neurological

deficits, and comorbid conditions, rather than stroke

subtype alone. Another important strength of the

present study is the robust statistical modeling

approach. Both calibration and discrimination of the

prediction model were assessed. The Hosmer–

Lemeshow goodness-of-t test indicated good model

calibration (χ² = 5.11, p = 0.746), demonstrating

agreement between observed and predicted outcomes.

Additionally, the area under the ROC curve (AUC =

0.799) indicated good discriminative ability of the

model in distinguishing between stroke types. These

findings support the reliability and predictive validity of

the regression model used in this study. The present

study has several strengths. It provides locally relevant

evidence regarding the relationship between

hypertension and stroke subtype, which remains limited

in Pakistan. Furthermore, the use of multivariable

logistic regression allowed adjustment for potential

confounding variables, thereby improving the accuracy

of the estimated associations. The inclusion of model

performance assessments, including ROC analysis and

the Hosmer–Lemeshow test, further strengthens the

credibility of the ndings. Overall, our ndings

reinforce the critical role of hypertension as a major

modifiable risk factor for stroke in the local population.

The high prevalence of hypertension among stroke

patients highlights the urgent need for improved blood

pressure screening, treatment adherence, and

community-level prevention strategies to reduce the

burden of stroke in Pakistan.

Frequency of Hypertension in Patients with Ischaemic

J Gandhara Med Dent Sci

April - June 2026

LIMITATIONS

A cross-sectional design from which we know only

association but not any causal relations. As it was a

hospital-based study, we could not assess milder cases.

By showing a strong association between hypertension

and ischaemic stroke, the importance of strict blood

pressure screening and control should be further

emphasized. Public health authorities should further

emphasize the importance of women’s blood pressure

control. Further research, including additional variables

such as glycaemic control, lipid prole, duration of

hypertension, smoking status, and renal function,

should be conducted. This predictive model should be

applied in multicenter studies to assess generalizability.

CONCLUSIONS

In this study of stroke patients, hypertension and older

age were identied as independent predictors of

ischemic stroke. After adjusting for confounders,

patients aged more than 50 years had a higher

likelihood of ischemic stroke than younger patients. In

contrast, BMI category, ICU admission, and medication

adherence were not signicantly associated with stroke

subtypes. Overall, these ndings highlight the

importance of hypertension and advancing age in the

distribution of stroke subtypes, which emphasize the

importance of early detection, monitoring, and eective

management of hypertension in the prevention of

ischemic stroke, especially in elderly populations.

Future research involving multiple centers and a

prospective design is needed to conrm this association

and its potential impact on stroke outcomes.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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Frequency of Hypertension in Patients with Ischaemic

J Gandhara Med Dent Sci

April - June 2026

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AUTHORS CONTRIBUTION

The authors accept responsibility for all aspects of the work

and will ensure that any concerns regarding the accuracy or

integrity of any part are properly investigated and resolved.

Saﬁullah - Concept & Design; Data Acquisition; Drafting

Manuscript; Critical Revision; Supervision; Final Approval

Abdul Wahab - Concept & Design; Data Acquisition; Drafting

Manuscript; Supervision; Final Approval

Muhammad Bilal- Concept & Design; Data Acquisition;

Drafting Manuscript; Critical Revision; Final Approval

Muhammad Ishfaq - Concept & Design; Data Acquisition;

Data Analysis/Interpretation; Drafting Manuscript; Critical

Revision; Supervision; Final Approval

Muhammad Usman Khattak - Concept & Design; Data

Acquisition; Drafting Manuscript; Critical Revision; Final

Approval

Sadiq Ali Shah - Concept & Design; Data Acquisition;

Drafting Manuscript; Supervision; Final Approval

Frequency of Hypertension in Patients with Ischaemic