The most appropriate management for this patient with hypertension and chronic kidney disease (CKD) is to continue the current medication regimen. Although hypertension is a common cause of CKD, hypertension is also highly prevalent in patients with CKD not caused by hypertension. The presence of hypertension in CKD promotes progression of underlying kidney disease and increases cardiovascular risk. Therefore, optimal management of hypertension is an important component of evaluating and treating all patients with CKD. For patients with CKD, the eighth report from the Joint National Committee (JNC 8) recommends a blood pressure target goal of <140/90 mm Hg using a medication regimen that includes an ACE inhibitor or angiotensin receptor blocker (ARB). In general, there is insufficient evidence to justify lower blood pressure goals unless patients have severely increased albuminuria, usually defined as >300 mg/g (stage A3), which is not present in this patient. His hypertension is currently at target goal, and he is taking an ACE inhibitor. Therefore, no changes to his medications are needed at this time.

The addition of the ARB losartan is inappropriate because the patient is already at goal blood pressure. Furthermore, studies have demonstrated that combination ACE inhibitor/ARB therapy worsens clinical outcomes and should not be used to treat patients with CKD.

Increasing this patient's lisinopril dose is unnecessary at this time because the patient is already at goal blood pressure.

Replacing lisinopril with amlodipine is not indicated because the JNC 8 guidelines recommend the use of an ACE inhibitor (such as lisinopril) or ARB as first-line therapy for hypertension in patients with CKD, and not dihydropyridine calcium channel blockers, which have a lower renoprotective effect. Additionally, this patient is at the recommended blood pressure goal.