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

Alana G Lerner, Antonio Bernabe-Ortiz, Robert H Gilman, Liam Smeeth, J Jaime Miranda, Alana G Lerner, Antonio Bernabe-Ortiz, Robert H Gilman, Liam Smeeth, J Jaime Miranda

Abstract

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.

References

    1. World Health Organization. Geneva: World Health Organization; 2005. Preventing chronic diseases: A vital investment.
    1. Joshi R, Jan S, Wu Y, et al. Global inequalities in access to cardiovascular health care: our greatest challenge. J Am Coll Cardiol. 2008;52:1817–1825.
    1. Institute of Medicine. Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. Washington, D.C.: The National Academy Press; 2010.
    1. Psaty BM, Lumley T, Furberg CD, et al. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA. 2003;289:2534–2544.
    1. Lawes CM, Vander Hoorn S, Rodgers A. Global burden of blood-pressure-related disease, 2001. Lancet. 2008;371:1513–1518.
    1. The Emerging Risk Factors Collaboration. Diabetes Mellitus, Fasting Glucose, and Risk of Cause-Specific Death. New England Journal of Medicine. 2011;364:829–841.
    1. Goldstein LB, Adams R, Becker K, et al. Primary prevention of ischemic stroke: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke. 2001;32:280–299.
    1. Turner RC, Holman RR. Lessons from UK prospective diabetes study. Diabetes Res Clin Pract. 1995;28(Suppl):S151–S157.
    1. Crews DC, Plantinga LC, Miller ER, 3rd, et al. Prevalence of chronic kidney disease in persons with undiagnosed or prehypertension in the United States. Hypertension. 2010;55:1102–1109.
    1. Elliott WJ. The economic impact of hypertension. J Clin Hypertens (Greenwich) 2003;5:3–13.
    1. Gaziano TA, Bitton A, Anand S, et al. The global cost of nonoptimal blood pressure. J Hypertens. 2009;27:1472–1477.
    1. Economic costs of diabetes in the U.S. In 2007. Diabetes Care. 2008;31:596–615.
    1. Dall TM, Zhang Y, Chen YJ, et al. The economic burden of diabetes. Health Aff (Millwood) 2010;29:297–303.
    1. Wilber JA. The problem of undetected and untreated hypertension in the community. Bull N Y Acad Med. 1973;49:510–520.
    1. Wilber JA, Barrow JG. Hypertension--a community problem. Am J Med. 1972;52:653–663.
    1. Hart JT. Rule of halves: implications of increasing diagnosis and reducing dropout for future workload and prescribing costs in primary care. Br J Gen Pract. 1992;42:116–119.
    1. Alwan A, Maclean DR, Riley LM, et al. Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. Lancet. 2010;376:1861–1868.
    1. Gao M, Ikeda K, Hattori H, et al. Cardiovascular risk factors emerging in Chinese populations undergoing urbanization. Hypertens Res. 1999;22:209–215.
    1. Niakara A, Fournet F, Gary J, et al. Hypertension, urbanization, social and spatial disparities: a cross-sectional population-based survey in a West African urban environment (Ouagadougou, Burkina Faso) Trans R Soc Trop Med Hyg. 2007;101:1136–1142.
    1. Miranda JJ, Gilman RH, Garcia HH, et al. The effect on cardiovascular risk factors of migration from rural to urban areas in Peru: PERU MIGRANT Study. BMC Cardiovasc Disord. 2009;9:23.
    1. Miranda JJ, Gilman RH, Smeeth L. Differences in cardiovascular risk factors in rural, urban and rural-to-urban migrants in Peru. Heart. 2011;97:787–796.
    1. Pedersen D, Tremblay J, Errazuriz C, et al. The sequelae of political violence: assessing trauma, suffering and dislocation in the Peruvian highlands. Soc Sci Med. 2008;67:205–217.
    1. Instituto Nacional de Estadística e Informática. Migraciones internas en el Perú [Internal migration in Peru] Lima, Perú: INEI; 1995. Available at: .
    1. O'Brien E, Waeber B, Parati G, et al. Blood pressure measuring devices: recommendations of the European Society of Hypertension. BMJ. 2001;322:531–536.
    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206–1252.
    1. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) Eur Heart J. 2007;28:1462–1536.
    1. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(Suppl 1):S5–S20.
    1. World Health Organization. Geneva: World Health Organization; 1997. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation on Obesity.
    1. Perneger TV. What's wrong with Bonferroni adjustments. BMJ. 1998;316:1236–1238.
    1. Sankoh AJ, Huque MF, Dubey SD. Some comments on frequently used multiple endpoint adjustment methods in clinical trials. Stat Med. 1997;16:2529–2542.
    1. Silva H, Hernandez-Hernandez R, Vinueza R, et al. Cardiovascular risk awareness, treatment, and control in urban Latin America. Am J Ther. 2010;17:159–166.
    1. Medina-Lezama J, Zea-Diaz H, Morey-Vargas OL, et al. Prevalence and patterns of hypertension in Peruvian Andean Hispanics: the PREVENCION study. J Am Soc Hypertens. 2007;1:216–225.
    1. Ordunez P, Barcelo A, Bernal JL, et al. Risk factors associated with uncontrolled hypertension: findings from the baseline CARMEN survey in Cienfuegos, Cuba. J Hypertens. 2008;26:663–671.
    1. Jo I, Ahn Y, Lee J, et al. Prevalence, awareness, treatment, control and risk factors of hypertension in Korea: the Ansan study. J Hypertens. 2001;19:1523–1532.
    1. Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. JAMA. 2010;303:2043–2050.
    1. Pastorius Benziger C, Bernabe-Ortiz A, Miranda JJ, et al. Sex differences in Health Care-Seeking Behavior for Acute Coronary Syndrome in a Low Income Country - Peru. Crit Pathw Cardiol. 2011;10:99–103.
    1. Wu Y, Huxley R, Li L, et al. Prevalence, awareness, treatment, and control of hypertension in China: data from the China National Nutrition and Health Survey 2002. Circulation. 2008;118:2679–2686.
    1. Ong KL, Cheung BM, Man YB, et al. Prevalence, awareness, treatment, and control of hypertension among United States adults 1999–2004. Hypertension. 2007;49:69–75.
    1. Falaschetti E, Chaudhury M, Mindell J, et al. Continued improvement in hypertension management in England: results from the Health Survey for England 2006. Hypertension. 2009;53:480–486.
    1. International Diabetes Federation. Diabetes atlas. 2nd ed. Brussels: International Diabetes Federation; 2003.
    1. Aschner P. Diabetes trends in Latin America. Diabetes Metab Res Rev. 2002;18(Suppl 3):S27–S31.
    1. Hu D, Fu P, Xie J, et al. Increasing prevalence and low awareness, treatment and control of diabetes mellitus among Chinese adults: the InterASIA study. Diabetes Res Clin Pract. 2008;81:250–257.
    1. Zhang Y, Dall TM, Mann SE, et al. The economic costs of undiagnosed diabetes. Popul Health Manag. 2009;12:95–101.
    1. Scheltens T, Bots ML, Numans ME, et al. Awareness, treatment and control of hypertension: the 'rule of halves' in an era of risk-based treatment of hypertension. J Hum Hypertens. 2007;21:99–106.
    1. Weinehall L, Ohgren B, Persson M, et al. High remaining risk in poorly treated hypertension: the 'rule of halves' still exists. J Hypertens. 2002;20:2081–2088.
    1. Chen R, Tunstall-Pedoe H, Morrison C, et al. Trends and social factors in blood pressure control in Scottish MONICA surveys 1986–1995: the rule of halves revisited. J Hum Hypertens. 2003;17:751–759.
    1. Deepa R, Shanthirani CS, Pradeepa R, et al. Is the 'rule of halves' in hypertension still valid?--Evidence from the Chennai Urban Population Study. J Assoc Physicians India. 2003;51:153–157.
    1. Cruickshank JK, Mbanya JC, Wilks R, et al. Hypertension in four African-origin populations: current 'Rule of Halves', quality of blood pressure control and attributable risk of cardiovascular disease. J Hypertens. 2001;19:41–46.
    1. Bloom DE, Cafiero ET, Jané-Llopis E, Abrahams-Gessel S, Bloom LR, Fathima S, Feigl AB, Gaziano T, Mowafi M, Pandya A, Prettner K, Rosenberg L, Seligman B, Stein A, Weinstein C. The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum; 2011.
    1. Leon DA. Cities, urbanization and health. Int J Epidemiol. 2008;37:4–8.
    1. Patel RB, Burke TF. Urbanization -- An Emerging Humanitarian Disaster. N Engl J Med. 2009;361:741–743.
    1. Yusuf S, Reddy S, Ounpuu S, et al. Global burden of cardiovascular diseases: Part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation. 2001;104:2746–2753.
    1. van Ginkel H. Urban Future. Nature. 2008;456:32–33.
    1. United Nations Population Fund. The State of World Population 2007: Unleashing the Potential of Urban Growth. New York: UNFPA; 2007.
    1. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21:1414–1431.

Source: PubMed

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