Virtual Reality Reduces Office Blood Pressure and Anxiety in Patients Undergoing Ambulatory Blood Pressure Monitoring: Enhanced Response among Those With a Pronounced White Coat Response.

Office blood pressure (OBP) may be transiently elevated during clinical encounters because of situational anxiety and stress-related physiologic arousal, contributing to diagnostic uncertainty and potential overtreatment. Virtual reality (VR)-based relaxation can reduce stress-related physiologic responses, but its effects on OBP and potential role in mitigating the white coat response among patients undergoing ambulatory blood pressure monitoring (ABPM) have not been evaluated. We conducted a prospective, single-arm, pre-post study among adults undergoing ABPM in a tertiary hypertension clinic. Participants completed paired OBP measurements and validated anxiety assessments before and after a brief immersive VR relaxation experience. ABPM results were used to classify predefined blood pressure subgroups. Seventy-eight participants completed the study (mean age 62 ± 15 years; 47% female). Across the cohort, systolic OBP decreased by 6.1 mmHg (95% CI, -7.6 to -4.6; p < 0.001) and diastolic OBP by 1.4 mmHg (p = 0.002) following VR exposure. Participants with a pronounced white coat response, prespecified as an office-to-daytime ambulatory systolic BP difference ≥15 mmHg, experienced the greatest systolic BP reduction (-12.2 mmHg; p < 0.001), compared with smaller or nonsignificant changes in other subgroups (between-group p = 0.005). Following VR exposure, 32.1% of participants were reclassified to a lower OBP category. Anxiety scores decreased significantly, and no adverse effects were reported. A brief VR relaxation intervention was associated with significant reductions in OBP and anxiety, particularly among participants with a pronounced white coat response, supporting its potential as an adjunct for improving OBP assessment in hypertension clinics. CLINICAL TRIAL REGISTRATION: Clinical Trials. gov Identifier: NCT06960057.