The rising prevalence of obesity among adolescents has become a global health concern, directly contributing to the early development of cardiovascular risk. This prospective multicenter cohort study aimed to investigate the dynamics of hemodynamic mechanisms underlying the formation of arterial hypertension (AH) in this patient category during the critical period of pubertal development. The study included 498 adolescents aged 12-17 years from major cities in the North Caucasus, stratified by body mass index. Over 24 months, a comprehensive examination was conducted, including 24-hour ambulatory blood pressure monitoring (ABPM), echocardiography with calculation of cardiac output (CO) and total peripheral resistance (TPR), assessment of pubertal stage (Tanner), bioimpedance analysis, and metabolic marker profiling. The prevalence of AH at the end of the observation period in the obesity group was 34.5%, which was 7.2 times higher than in the normal weight group (4.8%). A two-phase pattern of hemodynamic disturbances was revealed: in the early pubertal stages, a hyperkinetic type with high CO (6.4 [5.9; 7.0] L/min) predominated, while in the late stages, the leading role shifted to increased TPR (1690 [1560; 1820] dyn·s·cm⁻⁵), associated with insulin resistance (HOMA-IR 4.8 [4.0; 5.7]) and adipokine imbalance. Multivariate analysis confirmed that elevated TPR is an independent predictor of AH. The results demonstrate an evolution of the hemodynamic profile from a volume-dependent to a resistance-dependent form of AH with pubertal progression. This justifies the need for a differentiated approach to diagnosis and early intervention to prevent irreversible target organ damage.
