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Published mechanisms include upregulation of growth hormone receptor expression, promotion of angiogenesis via VEGF pathway activation, modulation of the nitric oxide system, and interaction with the dopaminergic and serotonergic systems in neurological models

However, there has been less emphasis on thiazide-like diuretics, despite evidence that both chlorthalidone and indapamide may offer better metabolic outcomes compared to hydrochlorothiazide (Kostis et al., 1997

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