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We report our long\u2010term single\u2010practice experience in an unusual group of five patients with chronic hyperaldosteronism (HA, including three with glucocorticoid\u2010remediable aldosteronism, GRA) treated with low\u2010dose amiloride (a specific epithelial sodium channel [ENaC] blocker) 5\u201010 (mean 7) mg daily for 14\u201028 (mean 20) years. Except for one GRA diagnosed in infancy, all had severe resistant hypertension. In each case, BP was normalized within 1\u20104\u00a0weeks after starting amiloride and office BP\u2019s remained well controlled throughout the next two decades. 24\u2010hour ambulatory BP monitoring with pulse wave analysis (cardiac output, vascular resistance, augmentation index, reflection magnitude), regional pulse wave velocities, pulse stiffening ratio, ankle\u2010brachial index, serum creatinine, estimated glomerular filtration rate, and spot urinary albumin:creatinine ratio were measured after a mean of 18\u00a0years; all of these indicators were essentially normal. Over two additional years of observation (100 patient\u2010years total), no cardiovascular or renal event occurred. We conclude that long\u2010term ENaC blockade with amiloride can normalize BP and protect macro\u2010 and microvascular function in patients with HA. This suggests that either (a) putative vasculopathic effects of aldosterone are mediated via ENaC or (b) aldosterone may not play a direct role in age\u2010dependent vasculopathic changes in humans independent of blood pressure. These findings, coupled with our literature review in both animal and human results, underscore the need for additional studies.<\/jats:p>","DOI":"10.1111\/jch.13597","type":"journal-article","created":{"date-parts":[[2019,7,26]],"date-time":"2019-07-26T11:19:55Z","timestamp":1564139995000},"page":"1183-1190","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Maintenance of long\u2010term blood pressure control and vascular health by low\u2010dose amiloride\u2010based therapy in hyperaldosteronism"],"prefix":"10.1111","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3570-8370","authenticated-orcid":false,"suffix":"Jr.","given":"Joseph L.","family":"Izzo","sequence":"first","affiliation":[{"name":"Department of Medicine, Jacobs School of Medicine University at Buffalo Buffalo New York"},{"name":"Erie County Medical Center Buffalo New 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