As with any medical condition, appropriate diagnostic evaluation is a critical component in the evaluation of a patient with suspected HTN. Evaluation focuses on determining possible causes of and/or comorbidities associated with HTN. Evaluation, as is detailed in the following sections, should include appropriate patient history, family history, physical examination, laboratory evaluation, and imaging. A complete physical examination may provide clues to potential secondary causes of HTN and assess possible hypertensive end organ damage. The child’s height, weight, calculated BMI, and percentiles for age should be determined at the start of the physical examination. Poor growth may indicate an underlying chronic illness. The purpose of the laboratory evaluation is to identify underlying secondary causes of HTN. Approximately one-half of adolescents with HTN have undergone electrocardiography at least once as an assessment for LVH. Echocardiography was identified in the Fourth Report as a tool to measure left ventricular (LV) target organ injury related to HTN in children. Emerging data demonstrate an association of higher levels of BP in youth with adverse changes in measures of vascular structure and function, including ultrasonography of the cIMT, PWV, a robust measure of central arterial stiffness66 that is related to hard CV events in adults. There are no evidence-based criteria for the identification of children and adolescents who may be more likely to have RAS. Some experts will do a more extensive evaluation for RAS in children and adolescents with stage 2 HTN, those with significant diastolic HTN.