- Hypertension is common in individuals with type 1 diabetes (T1D) and correlates with microvascular and macrovascular complications.
- Because few data are available in that population to guide management, most recommendations rely on data from trials in type 2 diabetes (T2D).
- There are differences in pathophysiologic mechanisms and cardiovascular burden between T1D and T2D, raising questions about the value of these recommendations in T1D.
- T1D prevalence is rising.
- Antihypertensive treatment should be initiated promptly in grade 1 hypertension.
- Patients with established cardiovascular disease should be treated when BP is within high-normal range.
- BP should be lowered toward 130/80 mmHg and lower, if well tolerated, and targeted below 130/80 mmHg in high-risk individuals.
- Lifestyle measures should always be implemented, even in individuals with high-normal BP.
- 2-drug combination of a renin-angiotensin system inhibitor plus calcium channel blocker or thiazide/thiazide-like diuretic is recommended as initial pharmacotherapy.
- Lack of data in T1D leaves many unanswered questions, including:
- Appropriate BP thresholds for treatment initiation and therapeutic goals.
- Whether patients with T1D and albuminuria would benefit from antihypertensive treatment if their BP is high-normal.
- Whether BP treatment initiation thresholds should differ in patients with vs without albuminuria.