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Background: Hypertension (HTN) is becoming a more recognized problem in pediatrics in general, though the prevalence is not changing despite the increasing prevalence of obesity.(1) The prevalence of borderline high and high blood pressure in children and adolescents appears to have plateaued at 11-12%. (1) Annual blood pressure measurement in patients being seen in pediatric practices has long been recommended. Our goal is to evaluate whether or not patients with HTN seen in a pediatric cardiology practice were appropriately diagnosed with HTN.Methods: A retrospective analysis of patients seen in the Texas Children’s Hospital Pediatric Cardiology outpatient clinics between 2005 and 2015 was performed. All blood pressure measurements, heights, weights, and BMI obtained at the same clinic visit were obtained from the electronic medical record. Patients with missing data were excluded from the analysisThe data was analyzed using SAS with calculations performed of means, standard deviations and interquartile ranges. Chi-squre and t-tests were used to compare means.Results: A total of 57,670 patients (53% male, mean age 8.7 +/- 8.3) were seen in clinic. The average BMI was 19 (range 0 to 95). There were a total of 125,750 visits, with a average number of visits 3.9 (range 1-64). 33,765 patients had blood pressure measurements in the pre-HTN or HTN range and 9,149 patients had Stage 2 HTN measured at the time of clinic visit. Most children (35,220, 61%) had only one visit and were therefore unable to truly be diagnosed with HTN. Of the remaining 22,450 patients, 3,751 (15%) patients had hypertensive blood pressure measurements on at least three occasions and 977 (26%) of those were diagnosed with HTN. The diagnosis of HTN was made in younger patients (p<0.001). Of those with the diagnosis of HTN, 691 (70%) were on antihypertensive medication. Younger patients were more likely to be treated for HTN than not, 10.3 +/- 11.7 years and 16.2 +/- 16.4 years respectively (p<0.001). Additionally proportionally females were more likely to be diagnosed with (p<0.001) and treated for HTN (p<0.001) than males.Conclusions: HTN is a common problem in pediatrics. In a pediatric cardiology practice, many patients have HTN that is undiagnosed. If HTN is diagnosed it is frequently either untreated or inadequately treated. While evaluation of blood pressure is being performed and documented in most patients adequate diagnosis and treatment is lacking.