Soru

A $72$-year-old man presents to the outpatient clinic for a routine follow-up. He reports that his home blood pressure readings have been consistently elevated in the $160$/$90 \text{ mm Hg}$ range over the past two months. His blood pressure was previously well-controlled on a stable regimen of lisinopril, amlodipine, and hydrochlorothiazide. He reports mild, worsening bilateral ankle swelling but denies chest pain, shortness of breath, or changes in urination. His past medical history is significant for essential hypertension, hyperlipidemia, and severe osteoarthritis of the knees. His surgical history includes an appendectomy in childhood. He drinks one glass of wine occasionally and has never smoked. Upon questioning, he reports adhering strictly to his prescribed medications and maintaining a low-sodium diet. He mentions that he started taking an over-the-counter naproxen twice daily three months ago for his knee pain because acetaminophen was no longer effective. Today, his blood pressure in the clinic is $168$/$96 \text{ mm Hg}$, and his pulse is $76\text{ /min}$. Laboratory studies show a serum creatinine of $1.5 \text{ mg/dL}$ (baseline $1.0 \text{ mg/dL}$ six months ago) and a serum potassium of $4.8 \text{ mEq/L}$.

Based on the medical history, which of the following is the most likely underlying mechanism for this patient's current clinical presentation?