Similarly to a series of chronic diseases, essential arterial hypertension (HTN) may be manifested during childhood as a blood pressure (BP) reading which repeatedly rises above the 95(th) percentile of population-specific standards. Since BP tends to track along the same percentiles throughout life, children with higher BPs are more likely to become hypertensive adults. When healthy measures aimed at reducing BP (i.e. body weight reduction, aerobic physical exercise, low sodium intake) have failed, pharmacological treatment is usually required. This paper aims to undertake a review of antihypertensive pharmacological therapy in children, examining the drugs used in chronic treatment as well as those administered to treat hypertensive crisis (i.e. a BP major than 99(th) percentile of paediatric normograms). Moreover, several important differences registered in the therapeutic approach to paediatric HTN between US and European Guidelines will be underlined.