Hypertension is a common condition in children with chronic kidney disease (CKD), which is often underestimated and tends to be uncontrolled during follow-up. Although it may not be the primary cause of kidney disease, elevated blood pressure influences the rate of progression to kidney failure. Characteristic for HTN is masked HTN, a non-dipping pattern, which requires ABPM for better assessment. Mechanisms for the development and maintenance of HTN include impaired sodium handling, overactivity of the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system, and disturbances in autoregulatory elements, although pharmacological treatments, mineral bone disease, hyperuricemia, and obesity are implicated in many cases. HTN is the most important modifiable factor with an impact on the progression of renal disease, and several studies have shown that both office and ambulatory SBP and DBP, as well as nocturnal BP, are associated with the risk of renal disease progression. Time-varying SBP appears to be more relevant than baseline values as a prognostic factor, and the presence of proteinuria exerts an additive effect on GFR decline and is a modifier of the renoprotective efficacy of intensified BP control. Recommendations for BP targets in patients with CKD are inconsistent in the published guidelines (ESH, AAP, KDIGO, Canadian) due to the small number of studies and the different designs and methods used. Dietary modification, DASH diet with or without sodium restriction, physical activity, and weight loss are recommended as adjuncts to medication, although the application of specific measures depends on the physiopathology and conditions of the entity causal of CKD. Clinical guidelines recommend the use of monotherapy, with dose escalation and the addition of a second drug if goals are not achieved with monotherapy. RAAS blockers, angiotensin converting enzyme inhibitors (ACEi), and angiotensin II receptor blockers (ARB) are the first recommended with the addition of CCBs or diuretics with thiazides or loop-diuretic. Two new classes of drugs with proven renal protection in adults are on the horizon for pediatric CKD, the sodium-glucose co-transporter 2 inhibitors (SGLT2i) and the non-steroidal mineralocorticoid receptor blocker finerenone, although their use in children requires specific studies.