• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home The Classics General Medicine Classics

The CHARM-Added trial: Adding candesartan to ACE inhibitor reduces mortality in heart failure [Classics Series]

byAndrew Cheung, MD MBA
November 30, 2015
in General Medicine Classics, The Classics
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

1. Angiotensin-converting-enzyme (ACE) inhibitors had been shown to significantly reduce mortality in patients with heart failure, and it was hypothesized that adding an angiotensin-receptor blocker (ARB) would provide further clinical benefit.

2. The addition of candesartan to ACE inhibitor treatment led to significant reductions in cardiovascular mortality and hospitalization for heart failure when compared to placebo.

3. Patients taking candesartan experienced significantly higher rates of serum creatinine elevation and hyperkalemia.

Original Date of Publication: September 2003

Study Rundown: Angiotensin II is the end product of the renin-angiotensin system, and it has been shown to be involved in the process of cardiac remodeling. ACE inhibitors, which impede the conversion of angiotensin I to angiotensin II, had been shown to reduce mortality in patients with congestive heart failure. It had also been shown, however, that angiotensin II production continues despite patients taking target doses of ACE inhibitors. Thus, it was hypothesized that adding ARBs would provide better inhibition of angiotensin II and potentially improve outcomes in patients with congestive heart failure. The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM)-Added trial was conducted to determine the effects of adding candesartan to the treatment of patients with congestive heart failure who were already on an ACE inhibitor. In summary, adding candesartan significantly reduced the risk of both cardiovascular death and hospitalization for heart failure when compared with placebo. Patients in the candesartan group experienced significantly higher rates of increased serum creatinine and hyperkalemia.

Previously, the Val-HeFT had found that adding valsartan to conventional therapy (i.e., 93% of patients were taking ACE inhibitors) led to no significant reduction in cardiovascular mortality, but did reduce the risk of hospitalization for heart failure. Authors of the CHARM-Added trial suggested that these differences could potentially be explained by the use of different ARBs and differences in dosing between the two studies. Current recommendations suggest considering a combination of ACE inhibitor and ARB only if aldosterone antagonists are not tolerated, though this combination may be harmful.

Click to read the study in The Lancet

RELATED REPORTS

#VisualAbstract: Torsemide does not provide additional decrease in mortality compared to furosemide among patients hospitalized for heart failure

Interatrial shunt device not effective in patients with symptomatic heart failure

Predicted long-term effects of dapagliflozin in heart failure suggest association with improved event-free survival

In-Depth [randomized controlled trial]: The CHARM-Added trial involved 2548 patients with a median follow-up of 41 months. Patients were eligible for the trial if they were ≥18 years of age, had left-ventricular ejection fraction (LVEF) ≤40%, had New York Heart Association (NYHA) class II-IV symptoms, and were already treated with an ACE inhibitor for 30 days or longer. Patients were randomized to receive either candesartan (i.e., started at 4 or 8 mg daily, titrated up to 32 mg daily) or placebo. The primary outcome was cardiovascular death or admission to hospital for the management of worsening heart failure.

Patients in the candesartan group experienced significantly lower rates of the primary outcome when compared to those in the placebo group (aHR 0.85; 95%CI 0.75-0.96). Patients on candesartan experienced significantly lower risk of cardiovascular death (aHR 0.83; 95%CI 0.71-0.97) and hospitalization for heart failure (aHR 0.83; 95%CI 0.71-0.97) compared to patients taking placebos. The candesartan group had significantly higher numbers of patients suffering from increased serum creatinine levels (p = 0.0001), hyperkalemia (p < 0.0001), or any adverse event or laboratory abnormality (p = 0.0003).

NEW LARGE Classics 2 Minute Medicine

©2015 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.

Tags: Angiotensincharm-added trialcongestive heart failure
Previous Post

Higher parental monitoring linked to safer sex in teens

Next Post

Mortality and morbidity may be increased in women with myocardial infarction or stroke

RelatedReports

#VisualAbstract: Torsemide does not provide additional decrease in mortality compared to furosemide among patients hospitalized for heart failure
StudyGraphics

#VisualAbstract: Torsemide does not provide additional decrease in mortality compared to furosemide among patients hospitalized for heart failure

January 27, 2023
30-Day mortality decreased in UK pediatric cardiac surgery from 2000-2010
Cardiology

Interatrial shunt device not effective in patients with symptomatic heart failure

March 29, 2022
Long-term outcomes for off-pump and on-pump CABG are similar
Cardiology

Predicted long-term effects of dapagliflozin in heart failure suggest association with improved event-free survival

November 8, 2021
Rilonacept may lower pericarditis recurrence in patients with relapsing pericarditis
Cardiology

Hemodynamic-guided management of heart failure may reduce hospitalization rates

September 22, 2021
Next Post

Mortality and morbidity may be increased in women with myocardial infarction or stroke

Increased cigarette tax linked to decreased infant mortality

Increased cigarette tax linked to decreased infant mortality

Probiotics improve colic, reduce GI disorders in infants

Probiotics not effective in preventing necrotizing enterocolitis: The PiPS trial

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • #VisualAbstract: Torsemide does not provide additional decrease in mortality compared to furosemide among patients hospitalized for heart failure
  • Community-based adult vision screening program increases access to eye care
  • Aspirin thromboprophylaxis noninferior to low-molecular-weight heparin in patients with fractures
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • The Scan
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

Want more physician-written
medical news?

Join over 10 million yearly readers and numerous companies. For healthcare professionals
and the public.

Subscribe for free today!

Subscription options