BACKGROUND: White coat hypertension (WCH) refers to patients with high blood pressure (BP) in a clinical setting but normal BP at home. Practical approaches are needed to rapidly obtain valid BP measures from these patients. Current practice includes having patients complete 24-hour ambulatory BP monitoring (at home). This approach is time-consuming and challenging for patients and clinicians. Practical approaches are needed to help acquire valid measurements in the clinic. An intervention with great potential is virtual reality. In this pilot study, we explore the use of virtual reality (VR) headsets. This intervention may be beneficial as calming scenes can be easily displayed to patients. PURPOSE: Have WCH patients complete a five-minute VR intervention (calm beach scene) and determine if BP decreases significantly. METHODS: All participants were patients at Mayo Clinic Florida who were previously diagnosed as having WCH by their physician (11 males, 19 females, age 55+). Patients who agreed to participate arrived 15 minutes early for a previously scheduled routine appointment. All BP measures were taken with a Welch Allyn Connex 6700 Vital Signs Monitor. First, a baseline BP measurement was collected. Then, the patient rested with no intervention for five minutes before having a second standard BP measurement taken. Finally, the patient wore the VR headset for five minutes (Oculus Quest 2 with Skybox VR Video Player). The VR displayed a “calming beach scene" and BP was collected again (at five minutes). Dependent t-tests (α=0.05) were used to test for significant differences in BP between the baseline and VR conditions. RESULTS: The systolic BP reduced significantly (p<0.01) from the first baseline measurement (154.2±22.9) to the second standard measurement (147.9±20.2). The BP further reduced (p=0.01) after the VR intervention (141.9±20.2). For diastolic BP, there was also a significant difference (p=0.18) (p=0.18, 0.02, 0.70) between the baseline (84.0±12.8) and standard (84.5±11.8). The diastolic BP reduced significantly (p=0.02) after the VR intervention (82.1±10.2). On five-point scale questions, 30 of 30 patients answered favorably when asked if the VR experience was “enjoyable” (4.74±0.50) and 28/30 believed it could lower their blood pressure (4.13±0.97). Further, only four of 30 participants reported feeling “nervous” while wearing the VR device (1.90±1.16). CONCLUSION: The VR device appeared to quickly reduce systolic and diastolic BP by a clinically relevant magnitude. Further, the vast majority of WCH participants responded positively to the intervention. This approach appears to have the potential to improve clinical practice. Future studies should focus on optimizing this approach for patients. Specifically, exposure time and relaxation scene need to be thoroughly researched.

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