NICE guidance states with respect to type 1 diabetes (1):
Blood pressure management
intervention levels for recommending blood pressure management should be 135/85 mmHg unless the adult with type 1 diabetes has albuminuria or 2 or more features of metabolic syndrome, in which case it should be 130/80 mmHg
start a trial of a renin-angiotensin system blocking drug as first-line therapy for hypertension in adults with type 1 diabetes
Do not allow concerns over potential side effects to inhibit advising and offering the necessary use of any class of drugs, unless the side effects become symptomatic or otherwise clinically significant. In particular:
do not avoid selective beta-adrenergic blockers where indicated in adults on insulin
low-dose thiazides may be combined with beta-blockers
when calcium channel antagonists are prescribed, use only long-acting preparations
use direct questioning to detect the potential side effects of erectile dysfunction, lethargy and orthostatic hypotension with different drug classes
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