56 year old male with HTN and DMII- poorly controlled due to insurance changes with noncompliance ((HbA1c 9.4, on insulin).
Creatinine 1.5 and eGFR 50 last month. Follow-up eGFR 43.
Resumed lisinopril 40mg (prior long-term regimen with HCTZ). SBP ranging 150s-170s, max SBP 200 in office, asymptomatic.
Should lisinopril be discontinued or should I consider additional antihypertensive medications? Options for imaging such as renal artery ultrasound or nephrology referral are limited.