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The addition of spironolactone as a fourth-line therapy has been shown to significantly improve blood pressure control, as demonstrated in the PATHWAY-2 trial

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Bethea M, Bozadjieva-Kramer N, Sandoval DA

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10.1210/en.2011-1443 [DOI] [PMC free article] [PubMed] [Google Scholar] Al-Harbi K