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A 65-year-old man with hypertension, obesity, and type 2 diabetes mellitus has been under your care for the past 5 years. He has been receiving hydrochlorothiazide (25 mg daily) and metformin (500 mg twice daily); his blood pressure is 130/82 mm Hg, his body-mass index (the weight in kilograms divided by the square of the height in meters) is 32, and his glycated hemoglobin is 7.5%. He comes to your office seeking advice about the management of his recently diagnosed coronary artery disease. Two weeks earlier, he had presented with chest tightness and shortness of breath after walking two blocks.
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