TJ is a 64-year-old man with long-standing hypertension. He has recently been diagnosed with chronic kidney disease and his estimated GFR is 24 mL/min. He is currently taking ramipril 10 mg daily. His blood pressure is 148/86 mm Hg, HR is 58 beats/ min, and electrolytes notable for a potassium of 5.1 mEq/L. Upon physical exam the patient is noted to have slight peripheral edema however ECHO was without evidence of systolic heart failure (ejection fraction estimated at 60%) however noted left ventricular dysfunction. Which of the following would be the most appropriate recommendation at this time? a. Continue current therapy and monitor BP regularly. b. Add HCTZ 12.5 mg daily. c. Add furosemide 20 mg daily. d. Start verapamil ER to 360 mg daily. e. Add spironolactone 25 mg daily

TJ is a 64-year-old man with long-standing hypertension. He has recently been diagnosed with chronic kidney disease and his estimated GFR is 24 mL/min. He is currently taking ramipril 10 mg daily. His blood pressure is 148/86 mm Hg, HR is 58 beats/ min, and electrolytes notable for a potassium of 5.1 mEq/L. Upon physical exam the patient is noted to have slight peripheral edema however ECHO was without evidence of systolic heart failure (ejection fraction estimated at 60%) however noted left ventricular dysfunction. Which of the following would be the most appropriate recommendation at this time? a. Continue current therapy and monitor BP regularly. b. Add HCTZ 12.5 mg daily. c. Add furosemide 20 mg daily. d. Start verapamil ER to 360 mg daily. e. Add spironolactone 25 mg daily

TJ is a 64-year-old man with long-standing hypertension. He has recently been diagnosed with chronic kidney disease and his estimated GFR is 24 mL/min. He is currently taking ramipril 10 mg daily. His blood pressure is 148/86 mm Hg, HR is 58 beats/ min, and electrolytes notable for a potassium of 5.1 mEq/L. Upon physical exam the patient is noted to have slight peripheral edema however ECHO was without evidence of systolic heart failure (ejection fraction estimated at 60%) however noted left ventricular dysfunction. Which of the following would be the most appropriate recommendation at this time?
a.    Continue current therapy and monitor BP regularly.
b.    Add HCTZ 12.5 mg daily.
c.     Add furosemide 20 mg daily.
d.    Start verapamil ER to 360 mg daily.
e.    Add spironolactone 25 mg daily