Pediatric hypertension is increasing in incidence, but remains greatly underrecognized, despite its severe long-term health consequences. Often discovered as incidental to another complaint, pediatric patients with hypertension may be asymptomatic but with markedly abnormal blood pressure, or they may have a true hypertensive emergency. This issue provides strategies to ensure that the child with asymptomatic hypertension receives appropriate screening and referrals, and outlines a systematic approach for the evaluation and treatment of the critically ill child who presents with symptoms of severe hypertension. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice.].