The "rule of halves" does not apply in Peru: Awareness, treatment, and control of hypertension and diabetes in rural, urban, and rural-to-urban migrants

Objective: To determine the awareness, treatment, and control of hypertension and diabetes by migration status. Design: Cross-sectional study, secondary analyses of the PERU MIGRANT study. Patients: Rural, rural-to-urban migrants, and urban participants. Main Outcome Measures: Awareness, treatment, and control of hypertension and diabetes mellitus were calculated using weights to account for participant's group size. Results: Of 205 of the 987 (weighted prevalence 24.1%, 95% confidence interval: 21.1%-27.1%) participants identified as hypertensive, 48.3% were aware of their diagnosis, 40% of them were receiving treatment, and 30.4% of those receiving treatment were controlled. Diabetes was present in 33 of the 987 (weighted prevalence 4.6%, 95% confidence interval: 3.1%-6%), and diabetes awareness, treatment, and control were 71.1%, 40.6%, and 7.7%, respectively. Suboptimal control rates, defined as those not meeting blood pressure or glycaemia targets among those with the condition, were 95.1% for hypertension and 97% for diabetes. Higher awareness, treatment, and control rates, for both hypertension and diabetes, were observed in rural-to-urban migrants and urban participants compared with rural participants. However, treatment rates were much lower among migrants compared with the urban group. Conclusions: These results identify major unmet needs in awareness, treatment, and control of hypertension and diabetes. Particular challenges are lack of awareness of both hypertension and diabetes in rural areas, and poor levels of treatment and control among people who have migrated from rural into urban areas.