2nd May 2024

A 72-year-old woman with a history of hypertension and type 2 diabetes presents with worsening shortness of breath and fatigue over the past 6 months.

A 72-year-old woman with a history of hypertension and type 2 diabetes presents with worsening shortness of breath and fatigue over the past 6 months. She has been adherent to her antihypertensive and antidiabetic medications. Physical examination reveals bilateral ankle oedema and rales at the lung bases. An echocardiogram shows left ventricular ejection fraction of 40%, with evidence of left ventricular hypertrophy. Blood tests show slightly elevated NT-proBNP levels.

Which is the most appropriate management plan?