Purpose of Review <p>Pediatric hypertension is associated with antecedent cardiovascular (CV) risk factors and the subsequent development of early subclinical CV disease. Current guidelines recommend the use of ambulatory blood pressure monitoring (ABPM) to diagnose and classify pediatric hypertension into distinct patterns. In recent years, emerging literature has explored the risk factors linked to these ABPM patterns and the associations of these patterns with target organ damage. This review summarizes studies published in the past five years that examine pediatric ABPM patterns and their relationship to cardiovascular risk.</p> Recent Findings <p>ABPM can be used to diagnose hypertension patterns, such as masked hypertension and non-dipping, that can not be identified through office-based measurements alone. This review of recent studies highlights multisystem risk factors that are associated with abnormal ABPM patterns in youth. It also presents growing evidence linking these patterns to target organ damage across pediatric populations with varying cardiovascular risk profiles.</p> Summary <p>Ambulatory blood pressure patterns in pediatric patients can be used to stratify cardiovascular risk in youth, before the onset of cardiovascular events.</p>