The incidence of hypertension is rising in the general population. A parallel trend is present in children and adolescents. This reflects more intensive treatment and improved patient survival after a wide range of serious systemic illnesses that can lead to hypertension. In addition, primary or essential hypertension is more prevalent because of the epidemic of obesity and metabolic syndrome in pediatric and adult patients of both genders and in all ethnic groups. As a consequence of the changing demographic pattern of hypertension, more patients are requiring therapy for elevated blood pressure. This review summarizes key aspects of the treatment for hypertension in pediatric patients and the long-term management of this problem, including nonpharmacologic strategies and drug treatment.