Blood pressure measurements should be taken at intervals on all children. At the very least, blood pressure measurements should be recorded on school and hospital admission. Once obtained, the pressure should be compared to established normals. If the pressure is repeatedly high, hypertension may be diagnosed and a cause sought. Unfortunately, most hypertension is usually mild in childhood, treatment programs should be initiated using nonpharmacologic measures. If needed a number of effective antihypertensive medications are available. The step-care approach presented in this article may be helpful in guiding the pediatric practitioner in this therapy.