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On the continuation of the cycle users usually do not notice strong changes in blood pressure, as this effect is also closely linked to estrogen and fluid retention. Genetic reasons also may play a role as some of the observations were made in siblings or twins. Indeed, ANG II was shown to be involved in cirrhosis-related portal hypertension (73, 74) and in the pathogenesis of insulin resistance and NAFLD, through its role in liver inflammation and fibrosis development (75, 76).

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