Valvular insufficiency (regurgitation) Quiz: Ace Your Exams

A 67-year-old man presents to the primary care clinic for follow-up of a recent echocardiogram. He has gradually developed chest discomfort and shortness of breath over the past few months. Stress testing with electrocardiogram did not show any inducible ischemic changes, so an echocardiogram was ordered. Transthoracic echocardiography performed last week showed moderate aortic regurgitation. The patient has a past medical history of chronic hyponatremia, gout, hypertension, major depressive disorder, and type 2 diabetes mellitus. Current medications include allopurinol, amlodipine, citalopram, glipizide, and metformin. Temperature is 37.0ºC (98.6ºF), pulse is 50/min, respiratory rate is 14/min, and blood pressure is 163/94 mmHg. On physical examination, the patient is well-appearing. The lungs are clear to auscultation. Cardiac examination reveals a blowing decrescendo early diastolic murmur heard at the right 2^nd intercostal space. Which of the following medications should be added to this patient’s treatment regimen?