A 58-Year-Old Man with Type 2 Diabetes Mellitus Comes to the Physician

question 531

Multiple Choice

A 58-year-old man with type 2 diabetes mellitus comes to the physician for a follow-up appointment.  His other medical problems include obesity and chronic kidney disease with a baseline creatinine of 1.5 mg/dL and urine protein excretion of 1100 mg/day.  He has failed to lose weight despite diet adjustments and aerobic exercise.  The patient takes insulin daily.  His blood pressure is 140/89 mm Hg and his pulse is 83/min.  Body mass index is 30 kg/m².  He is started on lisinopril 5 mg daily.
The patient returns for a follow-up appointment 2 weeks later and reports feeling well.  His blood pressure is 133/85 mm Hg.  Repeat testing shows creatinine of 1.8 mg/dL and potassium of 4.8 mEq/L.
Which of the following is the best next step in management of this patient?

• A)Add irbesartan and repeat testing in 2-3 weeks
• B)Continue lisinopril and repeat testing in 2-3 weeks
• C)Discontinue lisinopril and repeat testing in 2-3 weeks
• D)Switch to amlodipine and repeat testing in 2-3 weeks
• E)Switch to valsartan and repeat testing in 2-3 weeks