Table 2 Recommendations for people with type 1 diabetes

1. a. In people with type 1 diabetes and urine albumin:creatinine ratio (UACR) < 3 mg/mmol [< 26.55 mg/g]), we recommend a threshold for blood pressure therapy of a persistent upright (sitting or standing) blood pressure that is ≥140/90 mmHg (1B)^{a, b}.

b. In children and adolescents with type 1 diabetes, hypertension is defined as average systolic blood pressure and/or diastolic blood pressure that is greater than the 95th percentile for the person’s gender, age and height on more than three occasions (Grade 1B).

2. We recommend that angiotensin-converting-enzyme inhibitor (ACEI) therapy should be used as a first-line agent for blood pressure lowering and, if ACEI therapy is contraindicated or not tolerated, angiotensin receptor blockers (ARBs) should be considered (Grade 1B).

3. In most adults with type 1 diabetes and persistent UACR > 3 mg/mmol (> 26.55 mg/g), we recommend that ACEI therapy should be considered irrespective of blood pressure, and that the target upright blood pressure should be ≤130/80 mmHg (1B) if higher pre-treatment in younger adults but ≤140/90 mmHg for those aged over 65 (2D). We recommend that the dose of ACEI should be titrated to the maximum tolerated (Grade 1B).

4. There is no current evidence to support a role for ACEI therapy for blood pressure control or renal protection in people with type 1 diabetes who are normotensive and have UACR < 3 mg/mmol [< 26.55 mg/g]) (Grade 1C).

5. There is some evidence to support the use of candesartan to prevent the development or progression of retinopathy in people with type 1 diabetes who are normotensive and have UACR < 3 mg/mmol [< 26.55 mg/g]) (Grade 1C).

6. There is no firm evidence to support a role of dual blockade of the RAAS in people with type 1 diabetes (Grade 1C).

7. We recommend that people with type 1 diabetes should be advised to stop RAAS-blocking drugs during periods of acute illness and restart on recovery (Grade 1C).

8. We recommend that women of childbearing age should be encouraged to stop RAAS-blocking drugs prior to actively considering pregnancy (Grade 1B).