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VA’s New “Burden-free” Study Method Finds Two Blood Pressure Drugs Equally Effective

William C. Cushman, M.D., FACP, FAHA
William C. Cushman, M.D., FACP, FAHA

While a staff member at the VA Medical Center Memphis, Dr. William Cushman was Co-Chair of the Diuretic Comparison Project (DCP) from its planning stages through recruitment of VA medical centers/health care systems and patient selection.

This large VA clinical trial found that the blood pressure drug chlorthalidone (CTD) was not superior to hydrochlorothiazide (HCTZ) for the prevention of cardiovascular disease or non-cancer death.

Both drugs, commonly known as water pills are used to help the body rid itself of excess fluid, which can lower blood pressure.

The Diuretic Comparison was conducted at 537 VA medical centers and community clinics in the U.S. The trial enrolled more than 4,000 providers and 13,500 Veterans with high blood pressure who were taking HCTZ at baseline. Study participants were randomized to stay on their current dose of HCTZ or take an equivalent dose of CTD.

The study was funded by the VA Cooperative Studies Program. The study results were published online December 14, 2022, by the New England Journal of Medicine:

Chlorthalidone vs. Hydrochlorothiazide for Hypertension–Cardiovascular Events

About Dr. Cushman
Dr. Cushman began his VA career in Jackson, Mississippi, in 1977 and began participating as an investigator in VA Cooperative Study hypertension trials in 1978. In 1988, he moved to the Memphis VA Medical Center, where he served as Chief of the Hypertension and Preventive Medicine Sections until 2020 when he retired from the VA. Representing the VA, he was on the Executive Committee for the Seventh (2003) Joint National Committee Report on Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC 7) and co-authored the 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). Cushman was on the 2004 VA/Department of Defense (VA/DoD) Hypertension Clinical Practice Guideline committee and was the 2014 VA Champion and 2020 Co-Champion of the VA-DoD Hypertension Guidelines committees. He participated in designing and conducting hypertension and other trials, including several VA Cooperative Studies. Cushman was Chairman for PATHS (Prevention and Treatment of Hypertension Study), a multicenter clinical trial examining the effects of reducing alcohol intake on blood pressure in heavy drinkers and led the VA participation in the Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), a National Heart, Lung and Blood Institute (NHLBI) study comparing cardiovascular events from four major classes of antihypertensive agents. He was Co-Chair for the Diuretic Comparison Project (DCP), a randomized VA Cooperative Study comparing the effects of chlorthalidone vs hydrochlorothiazide on major cardiovascular events. Cushman was also Principal Investigator for the VA Clinical Center Network and Chair of the Blood Pressure Working Group of the NHLBI-sponsored Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial (2000-2010) and ACCORDION (-2015) extension, and Chair of the Intervention Subcommittee of the NHLBI-sponsored Systolic Blood Pressure Intervention Trial (SPRINT) (2009-2018).

Dr. Cushman was honored by the VA in 2010 with the first Barnwell Award for outstanding achievement in clinical science, the Department of Veterans Affairs Clinical Science Research and Development’s (CSR&D) highest national honor for scientific achievement. He received the 2017 Inter-American Society of Hypertension Lifetime Achievement Award and the American Heart Association’s Council on Hypertension 2018 Irvine Page-Alva Bradley Lifetime Achievement Award. He has over 350 journal article and book chapter publications, including many publications in NEJM, JAMA, and Lancet, and has received more than $60 million in research funding.




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