Recent evidence suggests that the blood pressure (BP) response to exercise may be useful in prediction of future hypertension. It has been shown that hypertensive youths have a higher systolic BP (SBP) response to exercise than their normotensive counterparts. Normotensive trained youths appear to have a higher BP response to exercise than untrained normotensive and in some instances hypertensive youths. While there is, at present, no clear explanation for this higher SBP response in trained youths, there is no evidence to suggest that these individuals are at increased risk of future health problems. Endurance-type conditioning is probably of benefit to hypertensive youths, and individuals with mild to moderate hypertension should not have restrictions of physical activity unless they show abnormalities during exercise testing. A lack of standardization in measuring and reporting SBP response to exercise exists. It is recommended that exercise BP measurement should be indirect, during upright exercise, recorded at more than one submaximal exercise level and at a steady state. The reference point for reporting BP should be the heart rate.