BS is a 66-year-old male who has a history of resistant hype…

BS is a 66-year-old male who has a history of resistant hypertension and kidney disease.  He has been using lifestyle modifications and is taking 4 medications for blood pressure that recently has been lowered to goal.  His laboratory tests are listed here: Serum potassium – 4.0 mEq/L (3.5-5.0 mEq/L) Serum creatinine – 1.5 mg/dL  (0.6-1.1 mEq/L) Creatinine Clearance – 40 mL/minute Urinary Albumin:Creatinine Ratio – 267 mg/g (< 30 mg/g)   Blood pressure medications: - Hydrochlorothiazide 25mg once daily - Losartan 100mg once daily - Nifedipine SR 60mg twice daily - Spironolactone 50mg daily   Allergies/Intolerances: NKDA   In clinic today, his blood pressures are 126/74 and 123/70 mm Hg His heart rates are 56 and 55 bpm. However, he complains of tenderness and pain in his chest area.  Upon examination he has enlargement of his chest tissue and is diagnosed with gynecomastia.