Observational studies of healthy children suggest that persistent elevations in BP are associated with significant late sequelae. In cross-sectional studies, elevated BP is associated with evidence of target-organ damage, including left ventricular hypertrophy and increased carotid intimal medial In longitudinal analysis from the Bogalusa Heart Study, high systolic or diastolic BP was associated with an increased risk of developing kidney failure during long-term and high childhood BP was an independent predictor of increased ankle brachial pulse wave velocity in Persistently elevated BP in the young has been associated with decreased measures of carotid artery In healthy children, in the absence of long-term data linking specific BP levels with adverse cardiovascular or kidney events, hypertension is defined on the basis of a population-based distribution. Specifically, hypertension is defined as average systolic BP or diastolic BP that is greater than or equal to the percentile for sex, age, and height on three or more In healthy children, the goal of anti-hypertensive treatment is reduction of the BP to below the 95th percentile, unless concurrent conditions are present. CKD is considered such a concurrent condition. In children with CKD, according to the Fourth Report on the Diagnosis, Evaluation, and Treat- ment of High BP in Children and Adolescents, the BP should be lowered to below the 90th percentile (http://www.nhlbi.nih. The rationale for this approach is similar to the recommended treatment of hypertension in adults with additional cardiovascular risk factors or co-morbid conditions. A number of expert panels have reviewed the existing literature and made similar recommendations. 