Background: PREHYPERTENSION is a major risk factor for development of hypertension, and cardiovascular disease. The incidence of PREHYPERTENSION is rising, the outcomes are poor, and the costs are high.Methods: The fourth Task Force Report on High blood pressure (BP) in Children and Adolescents does not consider PREHYPERTENSION to be a disease category, but rather a designation to identify individuals at high risk of developing hypertension, so that both patients and clinicians are alerted to this risk and encouraged to intervene and prevent or delay the disease from developing.Findings: Children and adolescents with PREHYPERTENSION can develop target organ damage including left ventricular hypertrophy, increased intima-media thickness and diastolic dysfunction. The goal of PREHYPERTENSION treatment in adolescents is to reach a BP level of<120/80 mm Hg. Physical activity and lifestyle modifications are the foundation of treatment for PREHYPERTENSION. Lifestyle interventions include weight reduction for overweight children, a regular aerobic exercise regimen, salt restriction, and adopting DASH diet (Dietary Approaches to Stop Hypertension). Achieving a normal body weight (BMI 18.5 to 24.0 kg/m2) may reduce systolic BP as much as 20 mm Hg and adopting DASH could result in a drop in systolic BP as great as 14 mm Hg. Keeping stress levels down also can help prevent progression of PREHYPERTENSION to full-blown hypertension. Pharmacologic therapy is recommended for PREHYPERTENSION associated with diabetes, chronic kidney disease cardiovascular disease or those who exhibit insufficient response to lifestyle modifications after 4 to 6 months.Conclusion: The recent findings in the management of PREHYPERTENSION in adolescents provide preventive strategies including lifestyle modifications and hypotensive therapy to reduce PREHYPERTENSION risk and progression.