Abstract
Cardiovascular assessments in children and adolescents with hypertension are essential for detecting early signs of organ damage and guiding timely interventions. The pathophysiology of pediatric hypertension involves a complex interplay of arterial stiffness, endothelial dysfunction, metabolic disturbances, activation of the renin-angiotensin-aldosterone system, and immune dysregulation. These mechanisms collectively contribute to target organ damage, particularly in the cardiovascular system. Traditional office-based blood pressure measurements often fail to identify individuals at high risk, prompting the adoption of more advanced diagnostic techniques. Measures of arterial stiffness, such as pulse wave velocity, augmentation index, and cardio-ankle vascular index, provide valuable insights into vascular health and have been strongly associated with left ventricular hypertrophy and impaired heart function. Imaging modalities, including carotid intima-media thickness and epicardial adipose tissue measurements, serve as indicators of subclinical atherosclerosis and cardiovascular risk. Advanced echocardiographic tools that assess myocardial strain and ventricular-arterial coupling provide a more nuanced understanding of cardiac performance in hypertensive adolescents. These advanced techniques enhance the early detection of cardiovascular abnormalities and support a more individualized approach to managing pediatric hypertension. However, challenges related to validation, standardization, and clinical integration remain. Thus, expanding access to these modalities and refining their use in pediatric populations are crucial steps toward improving long-term cardiovascular outcomes in youth with elevated blood pressure.