Abstract Background Self-monitoring of blood pressure is a key strategy in managing hypertension but may be challenging and burdensome for patients. The aim of the study was to describe the perspectives and experiences of self-monitoring of blood pressure in patients with hypertension. Methods MEDLINE, Embase, PsycINFO, and CINAHL were searched from database inception to March 2022. We used thematic synthesis to analyze the data. Results Thirty-five studies involving 872 patients aged 18–95 years were included. Four themes were identified: enabling autonomy and empowerment of own health (allowing access to comprehensive and accurate data, bolstering motivation for lifestyle changes, encouraging diligence in medication taking, gaining interest in self-management, and increasing awareness of health status); providing reassurance and convenience (instilling a sense of security, readiness for troubleshooting, and reducing the frequency of clinical appointments); triggering confusion and stress (anxiety and panic over “bad” numbers, constant reminder of illness identity, disregarded by clinicians, lack of confidence in interpreting and responding to results, redundancy of continuous monitoring, and uncertainties around targets and frequency of measures, concerns of unreliability); financial and operational burden of device (vulnerability preventing use, or unsustainable cost). Conclusions Inadequate knowledge about the benefits of lowering blood pressure, home blood pressure monitoring, blood pressure goals, and interpretation of blood pressure values, limited access to home blood pressure monitoring devices, and psychological burden with home blood pressure monitoring limit home blood pressure monitoring.