The prevalence of hypertension in children is increasing but its neurological effects are under-recognised. Here, we describe acute and chronic effects of childhood hypertension on the nervous system. Acute neurological involvement ranges from posterior reversible encephalopathy syndrome to, possibly, infarction and haemorrhage. Children with chronic hypertension are likely to have learning disabilities and deficiencies in executive function, which are potentially reversible with antihypertensive treatment. These cognitive defects may be secondary to abnormal regulation of cerebral blood flow. Raised blood pressure in childhood could also contribute to the early development of atherosclerosis, which can have both short-term and long-term adverse effects on vasculature. Clinical studies are needed to better define the full clinical range of paediatric hypertension on a child's nervous system. Furthermore, accurate biomarkers to define cognitive abnormalities and cerebral involvement need to be identified.
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