July 26th, 2020
A 75-year-old man comes to the physician because of a 6-month history of dyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, and peripheral edema. He has type 2 diabetes mellitus, hypertension, dyslipidemia, atrial fibrillation, and past ischemic stroke. Medications include ramipril, diltiazem, apixaban, rosuvastatin and metformin/empagliflozin. Pulmonary examination shows crackles at both lung bases. There is pitting edema of the lower legs and ankles. An echocardiogram shows an ejection fraction of 35%. Which of the following medications should be stopped in this patient?