Despite large sensitization, excess weight, hypertension and cardiovascular risk factors in children and adolescents are extending more and more, as a real new ‘epidemic’. Always more attention has been paid on epidemiology, causes, consequences and factors related to increase blood pressure values among young people. For the first time during 2009, the recommendations of the European Society of Hypertension for the management of high blood pressure in children and adolescents were published, remarking that the most important condition related to paediatric hypertension is the excess weight. The negative metabolic effects of obesity on blood pressure begin early during childhood and track through adolescence into adulthood. Waist circumference and waist-to-height ratio have emerged as better adiposity indicators than body mass index and important predictors of hypertension and cardiovascular risk. Also insulin resistance and high uric acid plasma levels have been advocated as relevant risk factors in children. Moreover a correlation between adipocytokines, in particular leptin and adiponectin, and hypertension and cardiovascular damage in children has been suggested. Obesity-associated hypertension results related to heart damage ( particularly an increase of the left ventricular mass), renal involvement ( presence of microalbuminuria) and autonomic alterations. As first therapy approach in hypertensive children, fundamental is the role of lifestyle measures: reduction of excess weight, increase of physical activity and limitation of sodium in the diet represent the main aspects of this kind of intervention.