A man in his 60s with hypertension, hyperlipidemia, and knee osteoarthritis presented with fatigue, decreased exercise tolerance, and worsening bilateral leg swelling. For 5 years, he had been prescribed lisinopril, simvastatin, and meloxicam as needed for pain. Over the past 3 months, he had been taking meloxicam, 15 mg daily, for worsening knee pain following a minor fall that led to a persistent sense of discomfort that limited him from pursuing recreational activities like biking and running but did not otherwise prevent him from performing his activities of daily living. He had not tried acetaminophen or other pain relievers before. During this same time, his lisinopril dose was doubled to 20 mg daily because his blood pressure had been slowly rising.
Kumar B, Swee ML. Nonsteroidal Anti-inflammatory Drug Use in a Patient With HypertensionA Teachable Moment. JAMA Intern Med. 2015;175(6):892-893. doi:10.1001/jamainternmed.2015.0809