OBJECTIVES: To describe the MORPHEOS (Morbidity in patients with uncontrolled HTN and OSA) trial, and describe the challenges imposed by the COVID-19 pandemic. METHODS: MORPHEOS is a multicenter (n=6) randomized controlled trial designed to evaluate the blood pressure (BP) lowering effects of treatment with continuous positive airway pressure (CPAP) or placebo (nasal strips) for 6 months in adult patients with uncontrolled hypertension (HTN) and moderate-to-severe obstructive sleep apnea (OSA). Patients using at least one antihypertensive medication were included. Uncontrolled HTN was confirmed by at least one abnormal parameter in the 24-hour ABPM and ≥80% medication adherence evaluated by pill counting after the run-in period. OSA was defined by an apnea-hypopnea index ≥15 events/hours. The co-primary endpoints are brachial BP (office and ambulatory BP monitoring, ABPM) and central BP. Secondary outcomes include hypertension-mediated organ damage (HMOD) to heart, aorta, eye, and kidney. We pre-specified several sub-studies from this investigation. Visits occur once a week in the first month and once a month thereafter. The programmed sample size was 176 patients but the pandemic prevented this final target. A post-hoc power analysis will be calculated from the final sample. ClinicalTrials.gov: NCT02270658. RESULTS: The first 100 patients are predominantly males (n=69), age: 52±10 years, body mass index: 32.7±3.9 kg/m2 with frequent co-morbidities. CONCLUSIONS: The MORPHEOS trial has a unique study design including a run-in period; pill counting, and detailed analysis of hypertension-mediated organ damage in patients with uncontrolled HTN that will allow clarification of the impact of OSA treatment with CPAP.

Resumo Fundamento: A importância da anatomia coronariana na predição de eventos cardiovasculares é bem conhecida. O uso de escores anatômicos tradicionais na cineangiocoronariografia de rotina, entretanto, não foi incorporado à prática clínica. O SYNTAX escore (SXescore) é um sistema de escore que estima a extensão anatômica da doença arterial coronariana (DAC). Sua capacidade para predizer desfechos com base na cineangiocoronariografia diagnóstica de base ainda não foi testada. Objetivo: Avaliar o desempenho do SXescore para predizer eventos cardíacos adversos maiores (MACE) em pacientes encaminhados para cineangiocoronariografia diagnóstica. Métodos: Coorte prospectiva de 895 pacientes com suspeita de DAC encaminhados para cineangiocoronariografia diagnóstica eletiva de 2008 a 2011, em hospital universitário no Brasil. Os pacientes tiveram seus SXescores calculados e foram estratificados em três categorias: 'sem DAC significativa' (n = 495); SXescoreBAIXO-INTERMEDIÁRIO: < 23 (n = 346); e SXescoreALTO: ≥ 23 (n = 54). O desfecho primário foi composto de morte cardíaca, infarto do miocárdio e revascularização tardia. Os desfechos secundários foram MACE e morte por todas as causas. Resultados: Em média, os pacientes foram acompanhados por 1,8 ± 1,4 anos. Desfecho primário ocorreu em 2,2%, 15,3% e 20,4% nos grupos 'sem DAC significativa', SXescoreBAIXO-INTERMEDIÁRIO e SXescoreALTO, respectivamente (p < 0,001). Morte por todas as causas foi significativamente mais frequente no grupo de SXescoreALTO comparado ao grupo 'sem DAC significativa', 16,7% e 3,8% (p < 0,001), respectivamente. Após ajuste para fatores de confusão, todos os desfechos permaneceram associados com o SXescore. Conclusão: O SXescore prediz independentemente MACE em pacientes submetidos a cineangiocoronariografia diagnóstica. Seu uso rotineiro nesse contexto poderia identificar pacientes de pior prognóstico.

Abstract Background: The importance of coronary anatomy in predicting cardiovascular events is well known. The use of traditional anatomical scores in routine angiography, however, has not been incorporated to clinical practice. SYNTAX score (SXscore) is a scoring system that estimates the anatomical extent of coronary artery disease (CAD). Its ability to predict outcomes based on a baseline diagnostic angiography has not been tested to date. Objective: To evaluate the performance of the SXscore in predicting major adverse cardiac events (MACE) in patients referred for diagnostic angiography. Methods: Prospective cohort of 895 patients with suspected CAD referred for elective diagnostic coronary angiography from 2008 to 2011, at a university-affiliated hospital in Brazil. They had their SXscores calculated and were stratified in three categories: no significant CAD (n = 495), SXscoreLOW-INTERMEDIATE: < 23 (n = 346), and SXscoreHIGH: ≥ 23 (n = 54). Primary outcome was a composite of cardiac death, myocardial infarction, and late revascularization. Secondary endpoints were the components of MACE and death from any cause. Results: On average, patients were followed up for 1.8 ± 1.4 years. The primary outcome occurred in 2.2%, 15.3%, and 20.4% in groups with no significant CAD, SXscoreLOW-INTERMEDIATE, and SXscoreHIGH, respectively (p < 0.001). All-cause death was significantly higher in the SXscoreHIGH compared with the 'no significant CAD' group, 16.7% and 3.8% (p < 0.001), respectively. After adjustment for confounding factors, all outcomes remained associated with the SXscore. Conclusions: SXscore independently predicts MACE in patients submitted to diagnostic coronary angiography. Its routine use in this setting could identify patients with worse prognosis.

OBJETIVO: Determinar a associação entre índice de massa corporal (IMC), índice cintura-quadril e cintura com a prevalência de hipertensão arterial (HAS) em amostra representativa de 1088 adultos de Porto Alegre, Brasil. MÉTODOS: Foram considerados hipertensos indivíduos com pressão sistólica (PAS) > ou = 160mmHg ou diastólica (PAD) > ou = 95mmHg e definidos como obesos aqueles com IMC > ou = 27kg/m², ou com razão cintura/quadril > ou = 0,95 (homens) e > ou = 0,80 (mulheres) ou com cintura > ou = 96cm (homens) e > ou = 92cm (mulheres). RESULTADOS: A obesidade aferida pelo IMC associou-se com a prevalência de HAS em ambos sexos (RR 1,9, IC 1,0 - 3,2 masculino; RR 2,2, IC 1,3 - 3,8 feminino). Os outros índices associaram-se, significativamente, apenas nas mulheres. CONCLUSÃO: IMC > ou = 27,0kg/m² associou-se mais, consistentemente, com o risco de HAS. A magnitude similar das associações dos demais indicadores demonstram sua utilidade na avaliação do risco para hipertensão.

PURPOSE: To evaluate the association between body mass index (BMI), waist-hip ratio and waist circumference with the prevalence of hypertension in a representative sample of 1088 adults of Porto Alegre (RS), Brazil. METHODS: In this cross-sectional survey, subjects were considered as having hypertension if they had systolic blood pressure > or = 160mmHg or diastolic > or = 90mmHg, and were considered obese if they had BMI > or = 27kg/m², or had a waist-hip-ratio > or = 0.95cm (men) or 0.80 (women) or had a waist circumference > or = 96 (men) or 92 (women). RESULTS: Obesity defined by the BMI was associated with hypertension in both genders (RR 1.9, CI 1.0 - 3.2 in men; RR 2.2, CI 1.3 - 3.8 in women). The other indices were significantly associated with hypertension just in women. CONCLUSION: BMI > or = 27.0kg/m² was strongly associated with increased odds to have hypertension. Similar magnitude of the association with the other indices indicate their utility to estimate the risk of hypertension.

O distúrbio de hiperatividade com déficit de atenção constitui síndrome comum na infância, pelo que é reconhecido como problema médico-social importante, sendo objeto de extensa investigação quanto aos seus determinantes, abordagens diagnosticas e formas de prevenção e tratamento. Dentro dos fatores que podem alterar a função cerebral, encontra-se a desnutrição. Os autores discutem a associação da síndrome com o estado nutricional de uma população de escolares.

The attention deficit hyperactivity disorder is a common childhood syndrome that is recognized as an important medical-social problem, being the object of an exhaustive investigation related to its etiology, diagnostic approach and prevention, and treatment forms. Among the factors that can alter the cerebral function, is the malnutrition. The authors discuss the association of the syndrome with the nutritional condition of students from elementary schools.

Com o objetivo de avaliar a prevalência de tabagismo em Porto Alegre, RS, Brasil, e os fatores associados, executou-se estudo observacional, de delineamento transversal e base populacional. Através de amostragem aleatória proporcional, por estágios múltiplos e conglomerados, selecionaram-se 1.091 indivíduos, a partir de 18 anos, que responderam a um questionário, em entrevista domiciliar. Aferiu-se o hábito de fumar através de perguntas dirigidas ao tipo de fumo, freqüência e tempo de exposição. A prevalência foi de 34,9% (IC 31,9 - 37,8), sendo de 41,5% (IC 38,5 - 44,4) entre os homens e 29,5% (IC 26,8 - 32,2) entre as mulheres. O início foi, em média, aos 16 (±5,6) e 17,8 (±6,7) anos, com moda de 15 e 14 anos, respectivamente. Os homens fumavam 19,0 ± 14,0 cigarros por dia e as mulheres 14,5 ± 10,3. Analisaram-se as associações através de regressão logística, incluindo-se no modelo sexo, idade, educação, renda, qualificação profissional e consumo de álcool. O hábito de fumar foi mais freqüente entre os homens, indivíduos de menor nível socioeconômico, dos 30 aos 39 anos, e entre os usuários de bebidas alcoólicas. Conclui-se que o tabagismo é freqüente em Porto Alegre, constituindo-se problema de saúde pública similar ao referido pela literatura. O consumo de álcool deve estar associado ao fumo por serem ambos comportamentos de risco, com determinantes comuns.

A cross-sectional study was carried out for the purpose of evaluating, the prevalence of smoking and the factors associated with it in Porto Alegre, a city in southern Brazilian. Through proportional, multiple stage, random sampling, 1.091 individuals (92% of those eligible) of 18 or more years of age, were interviewed at home. Exposure to smoking was measured by a questionnaire that inquired about the type, quantity and frequency of tobacco use. The prevalence of smoking was 34.9% (Cl 31.9 - 37.8). It was higher -among men - 41.5% (Cl 38.5 - 44.4) then women - 29.5% (Cl 26.8 - 32.2). The former started smoking at mean age of 16 (± 5.6), with mode of 15 and smoked an average of 19.0 (± 14.0) cigarettes per day. Females started at a mean age of 17.8 (± 6.7), with mode of 14 years old and smoked 14.5 (± 10.3). The association of the drinking habit and demographic and socioeconomic variables with smoking was evaluated through logistic regression. The variables included in the model were sex, age, education, income, professional qualification and alcohol consumption. The prevalence of smoking was greater for men, individuals of lower sociecinomic level, between 30 and 39 years of age, and among those accustomed to consuming alcoholic beverages. In conclusion, this study demonstrated that smoking is a public health problem in Brazil as in another countries. It is associated with sex, age, education and professional qualification, as has been observed elsewhere. The association of alcohol consumption with smoking may be understood as risk behavior, both having similar determinants.

Com o objetivo de avaliar a prevalência de tabagismo em Porto Alegre, RS, Brasil, e os fatores associados, executou-se estudo observacional, de delineamento transversal e base populacional. Através de amostragem aleatória proporcional, por estágios múltiplos e conglomerados, selecionaram-se 1.091 indivíduos, a partir de 18 anos, que responderam a um questionário, em entrevista domiciliar. Aferiu-se o hábito de fumar através de perguntas dirigidas ao tipo de fumo, freqüência e tempo de exposição. A prevalência foi de 34,9% (IC 31,9 - 37,8), sendo de 41,5% (IC 38,5 - 44,4) entre os homens e 29,5% (IC 26,8 - 32,2) entre as mulheres. O início foi, em média, aos 16 (±5,6) e 17,8 (±6,7) anos, com moda de 15 e 14 anos, respectivamente. Os homens fumavam 19,0 ± 14,0 cigarros por dia e as mulheres 14,5 ± 10,3. Analisaram-se as associações através de regressão logística, incluindo-se no modelo sexo, idade, educação, renda, qualificação profissional e consumo de álcool. O hábito de fumar foi mais freqüente entre os homens, indivíduos de menor nível socioeconômico, dos 30 aos 39 anos, e entre os usuários de bebidas alcoólicas. Conclui-se que o tabagismo é freqüente em Porto Alegre, constituindo-se problema de saúde pública similar ao referido pela literatura. O consumo de álcool deve estar associado ao fumo por serem ambos comportamentos de risco, com determinantes comuns.

A cross-sectional study was carried out for the purpose of evaluating, the prevalence of smoking and the factors associated with it in Porto Alegre, a city in southern Brazilian. Through proportional, multiple stage, random sampling, 1.091 individuals (92% of those eligible) of 18 or more years of age, were interviewed at home. Exposure to smoking was measured by a questionnaire that inquired about the type, quantity and frequency of tobacco use. The prevalence of smoking was 34.9% (Cl 31.9 - 37.8). It was higher -among men - 41.5% (Cl 38.5 - 44.4) then women - 29.5% (Cl 26.8 - 32.2). The former started smoking at mean age of 16 (± 5.6), with mode of 15 and smoked an average of 19.0 (± 14.0) cigarettes per day. Females started at a mean age of 17.8 (± 6.7), with mode of 14 years old and smoked 14.5 (± 10.3). The association of the drinking habit and demographic and socioeconomic variables with smoking was evaluated through logistic regression. The variables included in the model were sex, age, education, income, professional qualification and alcohol consumption. The prevalence of smoking was greater for men, individuals of lower sociecinomic level, between 30 and 39 years of age, and among those accustomed to consuming alcoholic beverages. In conclusion, this study demonstrated that smoking is a public health problem in Brazil as in another countries. It is associated with sex, age, education and professional qualification, as has been observed elsewhere. The association of alcohol consumption with smoking may be understood as risk behavior, both having similar determinants.