Hypertension is a major cause of morbidity and mortality throughout the world and an independent risk factor for cardiovascular disease. Although the incidence of hypertension is significantly greater in adults than children, recent trends reveal a rising percentage of children with high blood pressure. Coincident with the dramatic increase of the number of children with hypertension has been a growing field of knowledge regarding novel causes and therapeutic options for children with high blood pressure. Most reviews in pediatric hypertension focus on the many traditional causes of hypertension in children including renovascular disease, renal parenchymal disease, medication usage, endocrine causes (e.g. hyperthyroidism), and cardiovascular causes (e.g. coarctation of the aorta). However, recent research suggests that nontraditional causes of hypertension including chronic inflammation, low nephron number, prematurity/low birth weight, malnutrition, obesity (as part of the metabolic syndrome), hyperinsulinemia/insulin resistance, elevated uric acid, and dietary factors may be more common than previously thought. There are also innovative concepts in the treatment of childhood hypertension, including behavioral and combination drug therapy. In a rapidly evolving field and epidemic of children developing high blood pressure, it is therefore imperative for the generalist and specialist to be cognizant of the many changes occurring in the pathogenesis and management of childhood hypertension.