OBJECTIVES: Digital health interventions (DHIs) show considerable promise in supporting hypertension self-management by promoting preventative care and self-monitoring. While their efficacy is increasingly evident, the long-term uptake, acceptance and sustained engagement with these tools are frequently challenged by issues such as usability, trust and varying user experiences. This review aims to synthesise qualitative evidence to identify barriers and facilitators and the key factors that impact the adoption, acceptance and engagement with DHIs for hypertension self-management. DESIGN: Systematic review of qualitative literature using thematic analysis following Cochrane's qualitative and implementation methods guidance. DATA SOURCES: PubMed, PsycInfo, Web of Science and the Cochrane Library were searched in February 2025. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The searches included relevant qualitative and mixed-methods studies on the use of digital devices for hypertension management, which described the barriers and facilitators associated with these tools. We included studies published from 2015 to 2025 to capture relevant evidence. Only studies published in English with a qualitative approach were included. RESULTS: From an initial 10 943 identified publications, 15 met our inclusion criteria, primarily originating from Europe and the USA, exploring diverse racial and ethnic group experiences. Our thematic synthesis revealed 7 analytical and 22 descriptive themes detailing barriers and facilitators encountered by patients with hypertension, healthcare providers (HCPs) and caregivers. These themes covered technology utilisation, design components, linguistic and cultural relevance, healthcare factors, trust and credibility and interpersonal interactions. CONCLUSION: Our analysis underscores that factors such as the usability, design and relevance of social support profoundly influence the uptake and acceptance of DHIs in hypertension self-management among patients, caregivers and HCPs. PROSPERO REGISTRATION NUMBER: CRD42023480389.