<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:An 81-year-old man is admitted to the hospital due to acute decompensated heart failure. He has type 2 diabetes mellitus, hypertension, coronary artery disease, and congestive heart failure. Current medications include lisinopril, metformin, and low-dose aspirin. He has smoked one pack of cigarettes daily for 45 years. His temperature is 37.6C 99.7F, pulse is 105min and regular, respirations are 21min, and blood pressure is 10364 mm Hg. Laboratory studies show:Hemoglobin 13.7 gdLLeukocyte count 8200mm3SerumNa 128 mEqLCl- 98 mEqLK 4.9 mEqLUrea nitrogen 58 mgdLGlucose 200 mgdLCreatinine 2.2 mgdLWhich of the following changes in the medication regimen is most appropriate in this patient at this time?? A: Begin hydrochlorothiazide therapy, B: Begin vancomycin therapy, C: Discontinue aspirin therapy, D: Discontinue metformin therapy, E: Begin nitroprusside therapy,  <response>: This is a question about managing medications in an elderly patient hospitalized with acute decompensated heart failure and multiple comorbidities. The key findings are:- 81 year old man with multiple chronic conditions including diabetes, hypertension, coronary artery disease, and congestive heart failure- Admitted for acute decompensated heart failure exacerbation - Vital signs show tachycardia and hypotension consistent with decompensation- Labs show renal dysfunction with elevated BUN and creatinine along with hyperglycemia- He is on multiple medications including an ACE inhibitor, metformin, and aspirinThe goal is to identify the most appropriate medication change to make in this patient at this time. Choice A and E relate to managing his blood pressure, which is not the primary issue. Choice B is an antibiotic which is not indicated. Choice C about stopping aspirin seems reasonable given his renal dysfunction but is not directly related to his acute presentation. Choice D about stopping metformin is the best option since metformin can accumulate and cause lactic acidosis in the setting of renal dysfunction. D: Discontinue metformin therapy 