Hypertension is one of the major contributors to cardiovascular, renal and central nervous system morbidity and mortality. Although it is more prevalent in the adult population, hypertension and its sequelae are being seen in the pediatric population with increasing frequency. Blood pressure (BP) is not a static phenomenon. It is highly variable, changing constantly in response to various activities, stimuli, and stresses. Consideration of all of these factors make intermittent clinic BP measurements less effective in accounting for BP rhythmicity so ambulatory BP monitoring has emerged as a useful tool to give a detailed analysis of BP patterns during the day and night. It is becoming more and more evident that ABPM could be a useful tool in evaluation of white coat hypertension, apparent drug resistant hypertension, to evaluate efficacy of medications for control of hypertension, in evaluation of borderline hypertension, to further elaborate on chronology of hypertension and above all to assess the end organ damage risk as measurement of 24 hour BP parameters do correlate with hypertensive end organ injury.