Research - Key to Improving Pediatric Care

November 2004

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 referred the Shimada's to Dr. Musgrave, a physician researcher at Kapi'olani, to participate in a hypertension drug study for children.

The national study is being done in the hopes of providing physicians with reliable scientific data to improve treatment for children with high blood pressure. Kapi'olani is participating in the study through its affiliate research arm, Hawai‘i Pacific Health Research Institute.

Most drugs used to treat children, such as hypertension medication, have been studied for use in adults only. As a result, physicians have to prescribe medications for children "off label," which means they simply reduce the recommended adult dosage. This method is not optimal, because children are not little adults. Their unique physiology and ongoing development raises special concerns.

But this may eventually change for children such as Jessica who have high blood pressure. The study is specifically testing the impact and effectiveness of hypertension medication in children.

"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 Hawai‘i's children's hospital, Kapi'olani is dedicated to provide the best available medical care for children.

"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, Hawai‘i Pacific Health Research Institute.

Kapi'olani's emphasis on research brings state-of-the-art protocols to Hawai‘i's young patients, including treatment options that would not otherwise be 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 around the country on other studies focusing on timely children's health concerns. For example, because Hawai‘i 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 the 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 for the importance of physical activity to help manage her blood pressure. Jessica has started a regimen of walking and is learning some new exercise steps 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.

Statistically Speaking

Providing the newest, most promising treatment for children is the main goal of Kapi'olani Medical Center and the Hawai‘i Pacific Health Research Institute. To achieve that goal, the Research Institute oversees an impressive array of projects:

• More than 100 pediatric studies, covering areas such as oncology, cardiology, emergency medicine and neonatology.
• $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 that assures patient safety in all aspects of research.
• Extensive experience with clinical trials.

Click here to find out more about active clinical research studies at Kapi'olani.