MS is a 54-year-old male who is regularly seen in your clinic for his hypertension, diabetes, and hyperlipidemia.

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MS is a 54-year-old male who is regularly seen in your clinic for his hypertension, diabetes, and hyperlipidemia. He has been stable on enalapril 20 mg bid, HCT Z 25 mg q AM, and amlodipine 5 mg q AM for the last 3 years. He is returning today, 2 weeks since his last visit because his systolic blood pressure readings have been consistently over 140 when he awakens in recent weeks. Two weeks ago he was asked to increase the frequency of his blood pressure readings to several times a day, then return today. His blood pressure taken by you today is 144/88 and pulse of 92 with your cuff and 146/90 with his home device. MS typically exhibits white coat hypertension. About 70% of his home readings indicate a systolic pressure between 130 and 140, with the diastolic blood pressure readings typically in the mid- to high 70s. Almost all of the high readings are in the morning before he takes his medication or in the evening before he takes his second enalapril dose. Where do we go from here?

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