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You are correct that an ACE inhibitor is indicated in CHF patients. It also is recommended in diabetics because it has a protective effect on the kidneys. Although it is hard to say for sure, he may be concerned about her current kidney function or blood pressure. Your kidneys need to be working properly in order for an ACE inhibitor to have the desired effect. In my experience, metolazone is reserved for patients who's kidney function is poor. Also, the first 5 medications you listed all have blood pressure lowering effects. He may be concerned that her blood pressure will go to low if he adds yet another one. I do see one potential problem. Coreg and metoprolol are in the same class. This is a duplicate therapy and therefore one of them is unnessesary and may increase side effects. I would address this with her doctor right away and then ask him why he does not have her on an ACE inhibitor for her CHF and diabetes.
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