In deciding on treatment, unless severe hypertension is present, an individual s BP level should be determined as an average of multiple BP measurements taken over weeks Current recommendations suggest that measurements obtained by oscillometric devices that exceed the 90th percentile for age, sex, and height should be repeated by auscultation.319 Detailed descriptions of appropriate BP measurement techniques in children and the strengths and limitations of various BP measure- ment methods in children with CKD have been detailed previously in the KDOQI Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease, Guideline 13: Special Considerations in Although there is insufficient trial evidence to recommend the use of ABPM in this Guideline, by virtue of frequent measurement and recording, ABPM allows the practitioner to compute the mean BP during the day, night, and over 24 hours, as well as to assess the time in which BP exceeds the upper limit of the normal range (i.e., the BP load). A number of reviews and guidelines suggest that in children with CKD, ABPM is a particularly useful tool to assess BP patterns.320 322 In children, ABPM can be particularly useful, as a significant number of patients have masked hypertension and would not be recognized as having hypertension based on the outpatient measurements only. A few studies using ABPM in patients with CKD suggest that it may give a better measure of overall BP and better indicate risk for kidney disease progression than office BP measurement.12,77,323 In fact, the only large RCT of BP control in children with CKD used ABPM as the method for BP assessment.14 Further research may elucidate chapter 6 http://www.kidney-international.org & 2012 KDIGO that future guidelines for therapy should be based on ABPM, rather than office based measures that are commonly used today. 