Clinical practice. The child or adolescent with elevated blood pressure.

An audio version of this article is available at NEJM.org A 13-year-old boy visits his pediatrician because his school football team requires medical clearance before the start of the season. On physical examination, his weight is 72 kg (above the 99th percentile for age and sex) and his height is 155 cm (the 50th percentile); his body-mass index (the weight in kilograms divided by the square of the height in meters) is 30 (above the 99th percentile). His blood pressure is 134/77 mm Hg (the 99th percentile for systolic blood pressure and the 90th percentile for diastolic blood pressure), and his heart rate is 70 beats per minute. The serum creatinine level is 0.7 mg per deciliter (62 μmol per liter), and the urinalysis is normal. He is otherwise healthy and does not report any symptoms. His father has hypertension and type 2 diabetes. How should this case be further evaluated and treated?