Virtual Reality and Music Aid Early Blood Pressure Control in Hypertensive Urgency

Hypertensive urgency is a common emergency department presentation involving markedly elevated blood pressure without acute organ damage. Patients may also be anxious or frightened, and stress responses can further raise blood pressure. Standard care uses medication to lower pressure, but supportive approaches may help early stabilization. 

Researchers at the University of Health Sciences, Ankara City Health Application and Research Center (Ankara, Turkey) evaluated combined virtual reality (VR) and classical music therapy in adults with hypertensive urgency. The intervention used VR headsets showing a peaceful nature scene with a river, forest, tall trees, and a wooden suspension bridge. At the same time, patients listened on a smartphone to selected classical music by composers including Bach, Mozart, Debussy, Vivaldi, Tchaikovsky, Saint-Saëns, Haydn, and Corelli.

The randomized controlled trial included 130 adult emergency department patients, with 65 assigned to the intervention group and 65 to the control group. All participants received standard medication to lower blood pressure, while only those in the intervention group also received virtual reality (VR) and music. Blood pressure was measured at 15, 30, 60, 90, and 120 minutes, and anxiety was assessed using the State Anxiety Inventory.

Mean arterial pressure decreased in both groups, but the early reductions were greater among patients receiving VR and music. At 15 and 30 minutes, mean arterial pressure in the control group fell from 138 mmHg to 126 mmHg and 119 mmHg, respectively, while the VR group declined from 132 mmHg to 116 mmHg and 112 mmHg. These changes corresponded to reductions of 8% and 14% in the control group, compared with 12% and 15% in the VR group. After 30 minutes, however, the difference between groups was no longer significant.

“After 15 minutes, patients in the VR group had both a lower absolute blood pressure reading and a greater reduction from their starting point, compared to the control group. This was a statistically significant finding, meaning it was unlikely to be due to chance. The VR group's blood pressure dropped approximately 4–5 mmHg more than the control group. After that, the gap narrowed, and from 60 minutes onward the two groups were essentially equivalent,” said Dr. Kadir Yenal, emergency medicine specialist at Ankara Bilkent City Hospital.

The research, conducted at Ankara Bilkent City Hospital, was presented at the European Emergency Medicine Congress (EUSEM). The investigators cited several strengths, including the randomized controlled design, standardized blood pressure measurements, and the absence of patient dropouts. They also noted limitations, including baseline blood pressure differences, the single-center setting, the two-hour follow-up period, the combined use of VR and music, and the potential for placebo effects because patients and staff could see who was using the headsets.

“The suggestion of faster early blood pressure reduction in the first 15 minutes is clinically interesting. In a busy emergency department, getting blood pressure under control quickly is important—both for patient safety and for the efficient use of resources. If a non-drug intervention can accelerate that process even modestly, it has practical value,” said Dr. Safa Dönmez, the study’s first author and principal investigator and an associate professor of emergency medicine at the University of Health Sciences, Ankara City Health Application and Research Center.

Related Links
EUSEM
University of Health Sciences
Ankara Bilkent City Hospital