PURPOSE OF REVIEW: The purpose of this review is to describe the intersection between pediatric hypertension and advancing stages of cardiovascular, kidney metabolic syndrome in children and adolescents. RECENT FINDINGS: Cardiovascular-kidney-metabolic syndrome is highly prevalent in the pediatric population. The onset of CKM in childhood is influenced by the presence of antenatal risk factors such as maternal hypertensive disorders of pregnancy. Advancing stages of CKM in children and adolescents are strongly influenced by food insecurity and social determinants of health that impact the risk for childhood obesity. Activation of the renin-angiotensin-aldosterone system is a key mediator in the relationship between antenatal risk, early life course exposure and hypertension in children and adolescents. Effective strategies for slowing the rate of advancement of CKM staging in children and adolescents require attention to early course factors that influence the development of hypertension and obesity. Likewise, management strategies and therapeutic interventions that address these factors are critical to mitigating CKM stage advancement. Although hypertension is a component of the CKM framework, the presence of hypertension in children and adolescents drives higher CKM staging. Together, hypertension and higher CKM staging are associated with increased atherosclerotic cardiovascular disease risk. Social factors, including access to healthy foods and attention to early life course nutrition are critical strategies to improving CKM and hypertension related outcomes in children and adolescents.