Which of the following is not among the most frequent manifestations of mixed connective tissue disease?

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Mixed connective tissue disease tends to present with Raynaud’s phenomenon along with arthritis (often polyarthritis), myositis, and frequently interstitial lung involvement and skin changes. Granuloma formation is not a typical feature of this disease; granulomas are more characteristic of sarcoidosis and other granulomatous conditions. Hypertension also isn’t considered a frequent or defining manifestation of MCTD. The other described combinations align with the common spectrum—Raynaud’s phenomenon plus arthritis and interstitial lung disease; Raynaud’s phenomenon plus arthritis and myositis; Raynaud’s phenomenon plus polyarthritis and skin involvement. Therefore, the statement that includes granuloma formation and hypertension is not among the most frequent manifestations.