Hypertension is the most common form of cardiovascular disease. Although it is less common in adolescents than in adults, hypertension and the associated organ damage can and often does begin early in life. Consequently, for many with high blood pressure (BP), measures directed at the long-term prevention of cardiovascular morbidity may need to be started in adolescence to achieve maximal effectiveness. This article discusses some of the problems unique to hypertension in the young, as well as recent discoveries regarding the likely role played by increases in serum uric acid level in the development of adolescent-onset essential hypertension.