Final answer:
For a diabetic patient with hypertension and proteinuria, the next best step is to initiate an ACE inhibitor or ARB for their renal protective effects in addition to blood pressure control. This precedes other treatment adjustments such as changing metformin dosage or adding other antihypertensives.
Step-by-step explanation:
The 62-year-old female patient with a history of type 2 diabetes (DMII) taking metformin who presents with repeated hypertension readings and proteinuria should have their management plan updated to protect their cardiovascular and renal health. The presence of hypertension and proteinuria in a patient with DMII increases the risk of diabetic nephropathy, and cardiovascular disease, conditions commonly associated with diabetes. The next best step in management is A) Initiate angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). These medications are not just antihypertensive but also provide renal protection by reducing proteinuria. It is important to monitor renal function and potassium levels after initiation. Starting a beta-blocker, increasing metformin dosage, or administering diuretics, are not the most appropriate initial steps for kidney protection in this context.