Validez de la medida aislada de la presión arterial en farmacia comunitaria. Puntos de corte óptimos / Diagnostic validity of the isolated measurement of blood pressure in the community pharmacy. Optimum cut-off points

Introducción y objetivos: El objetivo es cuantificar la validez diagnóstica de la medida de la presión arterial en farmacia comunitaria (PAFC) y establecer los puntos de corte de la presión arterial sistólica (PAS) y de la presión arterial diastólica (PAD) que maximicen la citada validez, usando como patrón de oro la monitorización ambulatoria de la presión arterial (MAPA) de 24 h. Material y métodos: Estudio transversal, con selección consecutiva de pacientes usuarios de la farmacia comunitaria andaluza. Se midió la PAFC y, a continuación, una MAPA de 24 h, con lo que se evaluó la validez diagnóstica de PAFC. También se calculó el área bajo la curva ROC para PAS y PAD, los valores predictivos positivos y negativos para diferentes prevalencias, así como la variación de la sensibilidad y de la especificidad para los distintos puntos de corte de PAS/PAD, lo que sirvió para el cálculo de los puntos de corte óptimos. Resultados: Colaboraron 167 farmacias comunitarias, con 1.170 pacientes, de los que 1.110 aportaron datos válidos. La PAFC presenta una sensibilidad del 60,41% (IC 95%: 56,40-64,29), una especificidad del 79,77% (IC 95%: 76,12-82,99), un valor predictivo positivo de 76,96% (IC 95%: 72,89-80,57) y un valor predictivo negativo de 64,31% (IC 95%: 60,55%-67,90%). Por el método de curva ROC, los puntos de corte óptimos para la PAS y para la PAD son, respectivamente, 134/81mm Hg, puntos donde la sensibilidad y la especificidad se equilibran y se maximiza el índice de Youden. Conclusiones: La sensibilidad es relativamente baja. Para mejorarla se propone bajar el punto de corte de PAS y PAD. El óptimo calculado es 134/81mm Hg. Viene ello a aportar datos sobre la conveniencia de revisar a la baja el actual punto de corte (140/90), como propone la guía de 2017 de ACC/AHA

Introduction and objectives: The aim of this study is to determine the diagnostic validity of blood pressure measurement in the community pharmacy (CPBP), and to set the cut-off points in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in order to maximise the aforementioned validity, using 24 hour ambulatory blood pressure monitoring (ABPM) as the reference method. Material and methods: A cross-sectional study with consecutive selection of patient users of the community pharmacy in Andalusia. The CPBP was measured, followed by 24-hour ABPM, which assessed the diagnostic validity of the CPBP. The AUC of the ROC curve was also calculated for SBP and DBP, along with the positive and negative predictive values, for different prevalences and the variation of sensitivity and specificity for the different cut-off points for SBP/DBP. Results: A total of 167 community pharmacy participated with 1,170 patients, of which 1,110 were valid. The CPBP showed a sensitivity of 60.41% (95% CI: 56.40-64.29), and a specificity of the 79.77% (95% CI: 76.12-82.99), a positive predictive values of 76.96% (95% CI: 72.89-80.57), and a negative predictive values of 64.31% (95% CI: 60.55%-67.90%). By using the ROC curve method, the optimal cut-off points are 134/81mm Hg, the point where the sensitivity and specificity and are balanced and the Youden index is maximised. Conclusions: The sensitivity is relatively low. To improve it tends to lower the cut-off points of SBP and DBP. The calculated optimum is 134/81mm Hg. This provides data on the desirability to review the current cut-off points (140/90), as proposed by the ACC/AHA 2017

[Diagnostic validity of the isolated measurement of blood pressure in the community pharmacy. Optimum cut-off points]. / Validez de la medida aislada de la presión arterial en farmacia comunitaria. Puntos de corte óptimos.

INTRODUCTION AND OBJECTIVES: The aim of this study is to determine the diagnostic validity of blood pressure measurement in the community pharmacy (CPBP), and to set the cut-off points in systolic blood pressure (SBP) and diastolic blood pressure (DBP) in order to maximise the aforementioned validity, using 24 hour ambulatory blood pressure monitoring (ABPM) as the reference method. MATERIAL AND METHODS: A cross-sectional study with consecutive selection of patient users of the community pharmacy in Andalusia. The CPBP was measured, followed by 24-hour ABPM, which assessed the diagnostic validity of the CPBP. The AUC of the ROC curve was also calculated for SBP and DBP, along with the positive and negative predictive values, for different prevalences and the variation of sensitivity and specificity for the different cut-off points for SBP/DBP. RESULTS: A total of 167 community pharmacy participated with 1,170 patients, of which 1,110 were valid. The CPBP showed a sensitivity of 60.41% (95% CI: 56.40-64.29), and a specificity of the 79.77% (95% CI: 76.12-82.99), a positive predictive values of 76.96% (95% CI: 72.89-80.57), and a negative predictive values of 64.31% (95% CI: 60.55%-67.90%). By using the ROC curve method, the optimal cut-off points are 134/81mm Hg, the point where the sensitivity and specificity and are balanced and the Youden index is maximised. CONCLUSIONS: The sensitivity is relatively low. To improve it tends to lower the cut-off points of SBP and DBP. The calculated optimum is 134/81mm Hg. This provides data on the desirability to review the current cut-off points (140/90), as proposed by the ACC/AHA 2017.

Lewis base character of the phosphorus atom in phosphanido-niobocene complexes. Synthesis of new early-early homo- and heterobimetallic entities.

The reaction of phosphanido complexes [Nb(η(5)-C(5)H(4)SiMe(3))(2)(L)(PPh(2))] [L = CO (1), CNXylyl (2)] with early transition metal halides in high oxidation states has been carried out. New bimetallic niobocene complexes [{Nb(η(5)-C(5)H(4)SiMe(3))(2)(L)}(µ-PPh(2))(MCl(5))] [M = Nb, L = CO (3), L = CNXylyl (4); M = Ta, L = CO (5), L = CNXylyl (6)] have been successfully synthesized by the reaction with [MCl(5)](2) (M = Nb or Ta). In a similar way [{Nb(η(5)-C(5)H(4)SiMe(3))(2)(L)}(µ-PPh(2))(MCl(4))] [M = Ti, L = CO (13), CNXylyl (14); M = Zr, L = CO (15), CNXylyl (16)] were synthesized using MCl(4) (M = Ti or Zr). Solutions of complexes 4-6 in chloroform produced new ionic derivatives [Nb(η(5)-C(5)H(4)SiMe(3))(2)(P(H)Ph(2))(L)] [MCl(6)] [M = Nb, L = CO (7), L = CNXylyl (8); M = Ta, L = CO (9), L = CNXylyl (10)]. Ionic complexes [Nb(η(5)-C(5)H(4)SiMe(3))(2)(P(Cl)Ph(2))(L)] [NbCl(4)O(thf)] [L = CO (11), CNXylyl (12)] were formed from solutions in thf - rapidly in the case of 3 but more slowly for 4. New heterometallic complexes [Nb(η(5)-C(5)H(4)SiMe(3))(2)(L)(µ-PPh(2)){(Ti(η(5)-C(5)R(5))Cl(3)}] [R = H, L = CO (17), CNXylyl (18); R = CH(3), L = CO (19), CNXylyl (20)] were synthesized by the reaction of 1 or 2 with [Ti(η(5)-C(5)R(5))Cl(3)] (R = H or CH(3)). All of these compounds were characterized by IR and multinuclear NMR spectroscopy, and the molecular structures of 9 and 12 were determined by single-crystal X-ray diffraction.

Titanium and niobium imido complexes stabilized by heteroscorpionate ligands.

The reaction of [Ti(NR)Cl(2)(py)(3)](R = (t)Bu, p-tolyl, 2,6-C(6)H(3)(i)Pr(2)) with [{Li(bdmpza)(H(2)O)}(4)][bdmpza = bis(3,5-dimethylpyrazol-1-yl)acetate] and [{Li(bdmpzdta)(H(2)O)}(4)][bdmpzdta = bis(3,5-dimethylpyrazol-1-yl)dithioacetate] affords the corresponding complexes [Ti(NR)Cl(kappa(3)-bdmpzx)(py)](x = a, R = (t)Bu 1, p-tolyl 2, 2,6-C(6)H(3)(i)Pr(2) 3; x = dta, R =(t)Bu 4, p-tolyl , 2,6-C(6)H(3)(i)Pr(2) 6), which are the first examples of imido Group 4 complexes stabilized by heteroscorpionate ligands. The solid-state X-ray crystal structure of 1 has been determined. The titanium centre is six-coordinate with three fac-sites occupied by the heteroscorpionate ligand and the remainder of the coordination sphere being completed by chloride, imido and pyridine ligands. The complexes are 1-6 fluxional at room temperature. The pyridine ortho- and meta-proton resonances show evidence of dynamic behaviour for this ligand and variable-temperature NMR studies were carried out in order to study their dynamic behaviour in solution. The complexes [Nb(NR)Cl(3)(py)(2)](R = (t)Bu, p-tolyl, 2,6-C(6)H(3)(i)Pr(2)) reacted with [{Li(bdmpza)(H(2)O)}(4)] and (Hbdmpze)[bdmpze = 2,2-bis(3,5-dimethylpyrazol-1-yl)ethoxide], the latter with prior addition of (n)BuLi, to give the complexes [Nb(NR)Cl(2)(kappa(3)-bdmpzx)](x = a, R =(t)Bu 7, p-tolyl 8, 2,6-C(6)H(3)(i)Pr(2) 9; x = e, R = (t)Bu 10, p-tolyl 11, 2,6-C(6)H(3)(i)Pr(2)) 12 and these are the first examples of imido Group 5 complexes with heteroscorpionate ligands. The structures of these complexes have been determined by spectroscopic methods.

Heteroscorpionate ligands based on bis(pyrazol-1-yl)methane: design and coordination chemistry.

Scorpionates represent one of the most versatile types of tridentate ligand that can coordinate to a wide variety of elements, e.g. from early to late transition metals, and the coordination chemistry of these systems has developed greatly in recent years. This Perspective gives an account of studies on the following aspects: (1) the preparative methods for a new class of heteroscorpionate [RR'C(pz)2] ligand derived from bis(pyrazol-1-yl)methane and (2) the description of metal complexes containing these ligands, examples of which incorporate a range of different metals from the Periodic Table.

New complexes of zirconium(IV) and hafnium(IV) with heteroscorpionate ligands and the hydrolysis of such complexes to give a zirconium cluster.

A series of zirconium and hafnium heteroscorpionate complexes have been prepared by the reaction of MCl4 (M = Zr, Hf) with the compounds [[Li(bdmpza)(H2O)](4)] [bdmpza = bis(3,5-dimethylpyrazol-1-yl)acetate], [[Li(bdmpzdta)(H2O)](4)] [bdmpzdta = bis(3,5-dimethylpyrazol-1-yl)dithioacetate], and (Hbdmpze) [bdmpze = 2,2-bis(3,5-dimethylpyrazol-1-yl)ethoxide] (the latter with the prior addition of Bu(n)Li). Under the appropriate experimental conditions, mononuclear complexes, namely, [MCl3(kappa3-bdmpzx)] [x = a, M = Zr (1), Hf (2); x = dta, M = Zr (3), Hf (4); x = e, M = Zr (5), Hf (6)], and dinuclear complexes, namely, [[MCl2(mu-OH)(kappa3-bdmpzx)]2] [x = a, M = Zr (7), Hf (8); x = dta, M = Zr (9); x = e, M = Zr (10)], were isolated. A family of alkoxide-containing complexes of the general formula [ZrCl2(kappa3-bdmpzx)(OR)] [x = a, R = Me (11), Et (12), iPr (13), tBu (14); x = dta, R = Me (15), Et (16), iPr (17), tBu (18); x = e, R = Me (19), Et (20), (i)Pr (21), (t)Bu (22)] was also prepared. Complexes 11-14 underwent an interesting hydrolysis process to give the cluster complex [Zr6(mu3-OH)8(OH)8(kappa2-bdmpza)8] (23). The structures of these complexes have been determined by spectroscopic methods, and the X-ray crystal structures of 7, 8, and 23 were also established.

Preparation of new monoanionic "scorpionate" ligands: synthesis and structural characterization of titanium(IV) complexes bearing this class of ligand.

The preparation of new "scorpionate" ligands in the form of the lithium derivatives [(Li(bdmpzdta)(H(2)O))(4)] (1) [bdmpzdta = bis(3,5-dimethylpyrazol-1-yl)dithioacetate], [Li(bdphpza)(H(2)O)(THF)] (2) [bdphpza = bis(3,5-diphenylpyrazol-1-yl)acetate], and [Li(bdphpzdta)(H(2)O)(THF)] (3) [bdphpzdta = bis(3,5-diphenylpyrazol-1-yl)dithioacetate] has been carried out. Furthermore, a series of titanium complexes has been prepared by reaction of TiCl(4)(THF)(2) with the lithium reagents [(Li(bdmpza)(H(2)O))(4)] (4) [bdmpza = bis(3,5-dimethylpyrazol-1-yl)acetate] and 1. Under the appropriate experimental conditions neutral complexes, namely [TiCl(3)(kappa(3)-bdmpza)] (5), [TiCl(3)(kappa(3)-bdmpzdta)] (6), and [TiCl(2)(kappa(2)-bdmpzdta)(2)] (7), and cationic complexes, namely [TiCl(2)(THF)(kappa(3)-bdmpza)]Cl (8) and [TiCl(2)(THF)(kappa(3)-bdmpzdta)]Cl (9), were isolated. Complexes 8 and 9 undergo an interesting nucleophilic THF ring-opening reaction to give the corresponding alkoxide-containing species [TiCl(2)(kappa(3)-bdmpza)(O(CH(2))(4)Cl)] (10) and [TiCl(2)(kappa(3)-bdmpzdta)(O(CH(2))(4)Cl)] (11). A family of alkoxide-containing complexes of general formulas [TiCl(2)(kappa(3)-bdmpza)(OR)] [R = Me (12); R = Et (14); R = (i)Pr (16); R = (t)Bu (18)] and [TiCl(2)(kappa(3)-bdmpzdta)(OR)] [R = Me (13); R = Et (15); R = (i)Pr (17)] was also prepared. The structures of these complexes have been determined by spectroscopic methods, and in addition, the X-ray crystal structures of 3, 7, 10, and 11 were also established.