A 57 year old male presents to the office for a physical and…
A 57 year old male presents to the office for a physical and lab review. You note that his blood pressure is 180/90. He indicates that he has been very stressed out lately and that he has been having daily headaches. A repeat blood pressure in the office shows the patient continues to be elevated at 182/96. His last office visit showed his blood pressure to be 150/88 and at that time you counseled him on diet, exercise and weight loss. His most recent labs show elevated creatinine at 2.0 with a decrease in GFR to 55. His urine dipstick is negative for ketone, glucose and bilirubin but positive for protein. What is the most appropriate next step for him?