Background <p>Hypertension among children and adolescents is an escalating global health issue, significantly linked to cardiovascular risks and long-term complications in adulthood. Insulin-like growth factor 1 (IGF-1) is recognized for its role in growth and metabolism, yet its relationship with pediatric hypertension remains poorly understood. This study aimed to explore the association between IGF-1 levels and hypertension in children and adolescents.</p> Methods <p>Participants were categorized into Normal and Hypertension groups based on hypertension criteria. Demographic, anthropometric, and laboratory data were collected via medical records. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs).</p> Results <p>Data from 586 participants were analyzed. The prevalence of hypertension was 22.3% among the participants. Lower IGF-1 levels were significantly associated with an increased risk of hypertension. Compared to the highest quartile of IGF-1, the adjusted odds ratios (OR) for hypertension were 6.99 for quartiles 1 (<i>p</i> &lt; 0.05). The association was more pronounced in females, children aged 6–12 years, and those with abdominal obesity.</p> Conclusions <p>Lower IGF-1 levels are significantly associated with an increased risk of hypertension in children and adolescents. This association is evident across different subgroups, including sex, age, and obesity status. These findings highlight Maintaining the balance of these factors is critical for hypertension health, especially during adolescence.</p>