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Hypertension in adolescents: diagnosis, treatment, and implications. Hypertension is a major modifiable cardiovascular disease risk factor and its presence in childhood is associated with the presence and burden of atherosclerosis. Moreover, hypertension tracks from childhood to adulthood and is associated with adverse cardiac changes and vascular damage that in turn are associated with premature cardiovascular disease in adulthood. Therefore, the early identification and effective treatment of hypertension in children and adolescents is key in the primordial and primary prevention of cardiovascular disease, particularly for at-risk individuals, such as those with obesity, diabetes, or chronic kidney disease, among others. Unfortunately, hypertension can be difficult to diagnose in children and adolescents and is as such frequently under-recognised. In this Review, we provide an overview of hypertension in adolescents, with a focus on its prevalence and diagnosis, the rationale for early identification and treatment, and current knowledge gaps.