Although relatively rare in childhood, primary hypertension (PH) is thought to have originated in childhood and maybe even be determined perinatally. PH prevalence increases in school-age children and affects 11% of 18-year-old adolescents. Elevated blood pressure in childhood is associated with metabolic risk factors, which is carried into adulthood.

Analysis of hypertensive children’s phenotype has revealed that PH is a complex of anthropometric and neuro-immuno-metabolic abnormalities, typically found in hypertensive adults. Children with increased blood pressure have indicated signs of accelerated development, closely associated with further development of PH, cardiovascular disease, and metabolic syndrome in adulthood. At the time of diagnosis, hypertensive children were reported to have significant arterial remodeling expressed as significantly increased carotid intima-media thickness, increased stiffness of large arteries, the lower area of microcirculation, and decreased endothelial function. These changes indicate that their biological age is four to five years older than their normotensive peers. Such abnormalities are features of the early vascular aging observed in adults with PH.

In conclusion, the first vascular changes in hypertensive children are closely associated with markers of neuro-immuno-metabolic abnormalities and accelerated biological development observed in older subjects. It turns out that PH in childhood is also the first biological maturation phenomenon, apart from being an early vascular aging event.