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Research Key to improving pediatric care JESSICA SHIMADA WAS ONLY 12 YEARS old when a routine exam uncovered that she had high blood pressure. “Our family has a history of heart disease and stroke, and my wife and I take medication for high blood pressure, so we weren’t completely shocked,” Jessica’s father Andrew Shimada explains. Jessica’s pediatrician recommended that she be enrolled in a research project that studies hypertension in children at Kapi‘olani. Jessica’s case is an example of the problems facing pediatricians nationwide. Since most children don’t have high blood pressure, clinical studies about best medications have historically been directed toward adults. Therefore the exact dosage appropriate for Jessica is unknown. Pediatricians treating children are forced to make an educated guess based on adult dosages. This is called prescribing “off-label.” This traditional approach to prescriptions is not ideal because adults and children sometimes react to medications differently. However, this off-label practice is changing. The United States Food and Drug Administration agrees that medications used to treat children with high blood pressure should be clinically tested in children, to determine the best dosages and effectiveness. Kapi‘olani is one of several sites participating in research in medications for children. Physician researcher James Musgrave, M.D., is the principal investigator. Kapi‘olani is participating in the study through its affiliate research arm, Hawaii Pacific Health Research Institute. “We hope to gain an understanding from these studies that pinpoints the differences — and there certainly are differences — in how hypertension medications affect kids as compared to adults,” says Dr. Musgrave. Pediatric medicine: A promising future The hypertension medication trial at Kapi‘olani not only offers excellent care for young patients with high blood pressure, but also may affect the future of pediatric medicine. “This study and others like it may well change the way in which medications are used in children,” says Dr. Musgrave. As Hawaii’s only children’s hospital, Kapi‘olani is dedicated to provide the best available medical care for kids. James E. Musgrave, M.D. “The important improvements that have been achieved in children’s medical care are based primarily on new discoveries and knowledge,” says Dexter Seto, M.D., medical and scientific director, Hawaii Pacific Health Research Institute. Kapi‘olani’s emphasis on research brings state-of-the-art protocols to Hawaii’s young patients, including treatment options that would not be otherwise available. “Medical research is essential for today’s children and future generations of children,” says Dr. Seto. In addition to the hypertension study, Kapi‘olani and the Research Institute collaborate with pediatric centers across the country that focus on children’s health concerns. For example, because Hawaii has the highest rate of pediatric asthma in the nation, Kapi‘olani is participating in a study to prevent and manage asthma attacks in children. Also, to address the epidemic of “ice” or crystal methamphetamine use in the state, the hospital is involved with a study researching the long-term effects of the drug on children who were exposed to it in utero (before birth). A family affair One of the many children who benefits from Kapi‘olani research is Jessica Shimada. After a year in the hypertension study, Jessica’s family is pleased with her progress. “The study has been good for Jessica, and we want to do whatever we can to keep her healthy,” says her father. “Our ultimate goal for her is not to need medications to keep her blood pressure under control.” Participating in the study has raised the family’s awareness of the importance of physical activity to help manage her blood pressure. Jessica has started a regimen of walking and is learning some new exercises from fitness videos. “I remind Jessica that it’s best to nip high blood pressure in the bud while she is young, and not to wait until she is old like me,” says Andrew Shimada. Children’s Research in Hawaii Medical research is essential for the health of today’s children and future generations of children. Dexter Seto, M.D. To provide the newest, most promising treatments for children, Kapi‘olani’s clinical research includes: More than 100 pediatric studies, covering areas such as oncology, cardiology, emergency medicine, neonatology, infectious diseases, allergy, immunology, rheumatology $3.5 million targeted for current pediatric research A dedicated staff that includes more than 25 clinical research coordinators, and up to 75 physicians conducting studies A specialized Institutional Review Board assures patient safety in all aspects of research Extensive experience with clinical trials Click here to find out how you can help.