The patient has signs of hypertension. One would not wait to treat this patient with antihypertensive medications because she has a clearly abnormal blood pressure, she has signs of distension in her thoracic aorta and all of this is occurring in the setting of obesity (BMI 32 kg/meter squared) and diabetes mellitus with renal involvement. The latter is suggested by an albumin to creatinine ration greater than 29. The drugs of choice for the management of hypertension in the setting are ACE inhibitors, ARB inhibitors, and non-dihydropyridine calcium channel blockers. Diltiazem is a dihydropyridine Ca-channel blocker not indicated in this setting for control of blood pressure in diabetes. Thorp, ML. Am Fam Physician 2005;72:96-99,100