A new study published in the American Journal of Hypertension assessed the risk of surgical or endovascular intervention, and outcomes by etiology or extent of vascular disease. This retrospective study enrolled 93 children, in the age range of 7.0±5.4 observed over 30 years, with renal artery stenosis (RAS) and/or middle aortic syndrome (MAS), wherefrom data on vascular involvement (isolated RAS vs RAS with MAS), etiology (unknown, inflammatory, or genetic), and management were collected. The results revealed that the etiology was unknown in 50% of the cases, genetic in 26%, and inflammatory in 24% of children. Among these 49% children had isolated RAS while 51% had MAS with or without RAS. Overall, 70% of the cases were managed with surgical or endovascular intervention. It was also found that children with unknown etiology were more likely to undergo intervention compared to those with genetic and inflammatory diseases. On the other hand, children with RAS and MAS were less likely to receive intervention than those with isolated RAS. Further, 65% of the children remained hypertensive over a median follow-up of 2 years. While the longitudinal changes in systolic blood pressure did not differ by etiology, or between interventional and medical management. From the findings, it was concluded that hypertension persists despite endovascular or surgical management of childhood RAS and MAS underlining the importance of close monitoring and ongoing medical management.