Objective: To study signi®cant factors associated with the risk of hypertension among obese women, with and without a history of weight cycling (WC). Design: Case ± control study. Setting: Obesity Clinic of Chieti University, Italy. Subjects: A group of 258 obese women aged 25 ± 64 y (103 cases with hypertension and 155 controls) were recruited. All obese subjects had the same clinical characteristics, were without a family history for hypertension, were non-smokers, had normal lipidemic pro®les and normal glucose tolerance, were not taking any medication and were otherwise healthy. Intervention: In the weight cycling women, the history of WC was established on the basis of at least ®ve weight losses in the previous 5 y due to dieting, with a weight loss of at least 4.5 kg per cycle. A logistic regression model adjusted for confounding variables such as waist-to-hip ratio (WHR) and weight cycling history parameters was used and the odds ratio (OR) with 95% con®dence intervals was calculated. Results: The risk of hypertension increases in subjects with larger WHR (OR 7.8; 95% CI 3.4 ± 17.9) and with a positive history for WC (OR 4.1; 95% CI 2.4 ± 6.9). Further, in obese patients with WC, the weight cycling index and the sum of the weight regained are also important risk factors for hypertension. Conclusions: These ®ndings could support the hypothesis that it is the combined exposure of central-type obesity and WC that strongly raises the risk of hypertension. Sponsorship: This work has been ®nancially supported by a grant

The MIPP is a good tool for assessing clinical competence. Internationally, computer-based and standardized patient assessments are being used more often in licensing examinations. Continuous use of this method could improve medical graduates' performances.

OBJECTIVE: An association between body fat distribution indices and the amount of visceral adipose tissue (AT) with blood pressure (BP) has been documented. However, most studies used casual morning BP values as the dependent variable. The aim of our study was to identify which of the obesity indices (the body mass index (BMI), waist-to-hip ratio (WHR), sagittal diameter or visceral (AT) measured by ultrasonography (US)) better correlated with BP determined by 24 h ambulatory monitoring. DESIGN: Retrospective study on obese women, outpatients at the Obesity Clinic, Internal Medicine Institute, Chieti University, Italy. SUBJECTS AND MEASUREMENTS: In ®fty-one obese outpatient women, BP was determined with a single morning measurement (casual BP) and with 24 h ambulatory monitoring (ABPM). The obesity parameters were the BMI, WHR, sagittal diameter and the amount of intra-abdominal and subcutaneous fat determined by US. RESULTS: Except for the BMI, all obesity indices as WHR, sagittal diameter and visceral AT measured by US were strongly correlated with both casual and 24 h ambulatory BP values. When such parameters were evaluated in a multivariate analysis, only the WHR remained signi®cantly related to 24 h ABPM parameters and not to casual values. CONCLUSIONS: These results suggest that a simple measure of fat distribution as the WHR could represent a good predictor of hypertension in obesity, providing that BP is measured in a more reproducible manner, such as by 24 h ambulatory BP monitoring.

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