Objective:

To evaluate the effectiveness of digital health and wearable technology interventions on blood pressure (BP) control among stroke survivors.

Background:

Hypertension is a major modifiable risk factor for recurrent stroke. Digital health technologies, such as home BP monitors and smartphone applications, offer scalable solutions for continuous BP tracking and personalized management.

Design/Methods:

We systematically searched MEDLINE, Embase, and CENTRAL (inception–September 2025) for studies involving adults with prior stroke or transient ischemic attack using wearable or digital health tools for secondary prevention. Randomized clinical trials (RCTs), single-arm interventional, and observational studies were included. Random-effects meta-analyses were performed using DerSimonian–Laird methods. Risk of bias was assessed using RoB-2 and ROBINS-I.

Results:

Fourteen studies (n=1,783 total; mean age 58 years; 39% women) reported BP outcomes, including nine RCTs. Most interventions combined home BP monitoring with education, reminders, and clinician feedback. Across seven studies with compatible data, digital health–interventions reduced SBP by –6.17 mmHg (95% CI: -12.96 to 0.62) and DBP by –0.49 mmHg (95% CI: 4.62-3.63). Consistent within-arm reductions and higher BP control rates were seen in non-pooled studies. Studies integrating remote monitoring with structured medication titration or clinician follow-up achieved the largest within-arm SBP reductions (≈ 8–12 mm Hg) and the highest BP-control rates (> 60 %), whereas passive monitoring alone produced smaller effects. There was a nonsignificant trend toward larger BP reduction with higher starting BP (slope = −0.34 mm Hg per 1 mm Hg baseline; 95 % CI: −1.67-0.99; k = 7). Heterogeneity was high (I²=87%), reflecting variability in intervention intensity and device type.

Conclusions: