Effect of Virtual Reality and Classical Music Therapy on Blood Pressure and Anxiety in Patients With Hypertensive Urgency
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- Ankara City Hospital Bilkent
- Enrollment
- 130
- Locations
- 1
- Primary Endpoint
- Change in Mean Arterial Pressure (MAP) at 30 Minutes
Study Overview
Brief Summary
This study aims to evaluate whether virtual reality (VR) and classical music therapy, when added to standard antihypertensive treatment, can improve blood pressure control and reduce anxiety in patients presenting to the emergency department with hypertensive urgency. Patients with primary hypertension and no signs of end-organ damage will be randomly assigned to receive either standard treatment alone or standard treatment combined with VR and classical music. Blood pressure will be monitored at multiple time points over a 120-minute period, and anxiety will be assessed using the State Anxiety Inventory (STAI-I). The study seeks to determine if these non-pharmacological interventions can enhance the effectiveness of routine management of hypertensive urgency.
Detailed Description
Hypertensive urgency is characterized by severely elevated blood pressure without evidence of acute target-organ damage. Standard management typically involves the gradual reduction of blood pressure using oral antihypertensive agents such as captopril. Emotional stress and anxiety can contribute to elevated sympathetic activity, potentially worsening blood pressure control. Virtual reality (VR) environments and classical music therapy have been shown in prior studies to reduce stress, improve patient comfort, and modulate physiological responses.
In this randomized controlled study, patients with primary hypertension who present to the emergency department with hypertensive urgency will be assigned to one of two groups: standard pharmacological treatment alone or standard treatment combined with VR exposure and classical music therapy. The intervention will be delivered in a quiet and dimly lit room, and blood pressure will be measured at predefined intervals over 120 minutes. Anxiety levels will be assessed at baseline and at the end of the monitoring period using the State Anxiety Inventory (STAI-I).
This study aims to determine whether VR and classical music can enhance routine management by improving early percentage change in mean arterial pressure and decreasing anxiety levels during acute hypertensive episodes. Findings may support the incorporation of non-pharmacological strategies into the emergency management of hypertensive urgency.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Age 18 years or older
- •Clinical diagnosis of primary hypertension
- •Presentation to the emergency department with hypertensive urgency
- •Absence of any signs of acute end-organ damage
- •Ability to understand the study and provide informed consent
- •Able to cooperate with serial blood pressure measurements
Exclusion Criteria
- •Age younger than 18 years
- •Diagnosis of secondary hypertension
- •Any medication intolerance or known hypersensitivity to captopril or nitrate therapy
- •Current severe psychiatric disorder or cognitive impairment interfering with participation
- •Contraindications to using virtual reality (history of severe vertigo, epilepsy, motion sickness, etc.)
- •Hemodynamic instability requiring immediate high-intensity medical intervention
- •Pregnancy or breastfeeding
- •Inability or unwillingness to provide informed consent
Arms & Interventions
Standard Pharmacological Treatment
Participants in this arm will receive standard oral antihypertensive treatment consisting of 25 mg captopril. Additional doses (25 mg at 30 minutes and 25 mg at 60 minutes, total 75 mg) will be administered if systolic blood pressure remains ≥180 mmHg or diastolic blood pressure remains ≥110 mmHg during follow-up. Rescue therapy with IV nitrate (0.1 mg/kg/min) will be used if blood pressure remains uncontrolled after 90 minutes, following routine emergency department protocol. No VR or music therapy is administered in this arm.
Intervention: Captopril 25Mg Tab (Drug)
Standard Treatment + VR and Classical Music Therapy
Participants in this arm will receive standard oral antihypertensive treatment consisting of 25 mg captopril. Additional doses (25 mg at 30 minutes and 25 mg at 60 minutes, total 75 mg) will be administered if systolic blood pressure remains ≥180 mmHg or diastolic blood pressure remains ≥110 mmHg during follow-up. In addition to standard treatment, participants will receive virtual reality exposure combined with classical music therapy. Patients will view a calming VR environment while listening to a selected piece of classical music. VR and music therapy are administered concurrently in a quiet and dimly lit room. Rescue therapy with IV nitrate (0.1 mg/kg/min) will be used if blood pressure remains uncontrolled after 90 minutes, following the same emergency department protocol as the control group.
Intervention: Captopril 25Mg Tab (Drug)
Standard Treatment + VR and Classical Music Therapy
Participants in this arm will receive standard oral antihypertensive treatment consisting of 25 mg captopril. Additional doses (25 mg at 30 minutes and 25 mg at 60 minutes, total 75 mg) will be administered if systolic blood pressure remains ≥180 mmHg or diastolic blood pressure remains ≥110 mmHg during follow-up. In addition to standard treatment, participants will receive virtual reality exposure combined with classical music therapy. Patients will view a calming VR environment while listening to a selected piece of classical music. VR and music therapy are administered concurrently in a quiet and dimly lit room. Rescue therapy with IV nitrate (0.1 mg/kg/min) will be used if blood pressure remains uncontrolled after 90 minutes, following the same emergency department protocol as the control group.
Intervention: Virtual Reality Exposure (Device)
Standard Treatment + VR and Classical Music Therapy
Participants in this arm will receive standard oral antihypertensive treatment consisting of 25 mg captopril. Additional doses (25 mg at 30 minutes and 25 mg at 60 minutes, total 75 mg) will be administered if systolic blood pressure remains ≥180 mmHg or diastolic blood pressure remains ≥110 mmHg during follow-up. In addition to standard treatment, participants will receive virtual reality exposure combined with classical music therapy. Patients will view a calming VR environment while listening to a selected piece of classical music. VR and music therapy are administered concurrently in a quiet and dimly lit room. Rescue therapy with IV nitrate (0.1 mg/kg/min) will be used if blood pressure remains uncontrolled after 90 minutes, following the same emergency department protocol as the control group.
Intervention: Classic Music Therapy (Behavioral)
Outcomes
Primary Outcomes
Change in Mean Arterial Pressure (MAP) at 30 Minutes
Time Frame: Baseline (after 10 minutes of rest) and 30 minutes after treatment initiation
Mean arterial pressure will be measured at baseline (after 10 minutes of rest) and again at 30 minutes after the initial treatment. The primary endpoint is the percentage change in MAP at 30 minutes compared with baseline. Positive values indicate a reduction in MAP.
Secondary Outcomes
- Change in State Anxiety Level (State Anxiety Inventory - Form I)(Baseline and 120 minutes)
- Incidence of Adverse Events(Up to 120 minutes)
- Change in State Anxiety Level (State Anxiety Inventory - Form I)(Baseline and 240 minutes)
- Incidence of Adverse Events(Up to 240 minutes)
Investigators
Safa Dönmez
Associate Professor
Ankara City Hospital Bilkent