A 57-year-old female with a history of hypertension comes to the physician because of shortness of breath. She says that she has been experiencing progressively worsening dyspnea while climbing the stairs in her house. She denies both chest pain and dyspnea at rest. She appears comfortable at rest. She is on aspirin and metoprolol. Physical examination shows a regular heart rate and rhythm with absence of murmurs or rubs but does have an S4. Blood pressure is 150/80 mm Hg and pulse 55/min.

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... nary exam reveals rales at the bases. She has lower extremity edema. Echocardiogram shows increased LV filling pressures with a normal ejection fraction. Which of the following is the next best step? A. Candesartan, B. Digoxin, C. Reduce the dose of metoprolol, D. Verapamil, E.