A 64-year-old man comes to the physician for a 5-month history of progressively worsening fatigue and shortness of breath with exertion. He has a background of dyslipidemia and hypertension but takes no medications. He does not have diabetes. He is a non-smoker. Blood pressure is 150/90. Auscultation of the chest shows mild bibasilar crackles. A chest x-ray shows cephalization of the pulmonary vessels. Echocardiogram shows mild left-ventricular concentric hypertrophy with reduced ejection fraction and left atrial dilatation. Which of the following is the most appropriate next step in pharmacologic management?
A) Bisoprolol
B) Digoxin
C) Hydralazine and isosorbide dinitrate
D) Lisinopril
E) Spironolactone
