Objective To systematically evaluate the effectiveness of mobile health (mHealth) management interventions for older patients with hypertension, and to provide evidence for standardizing and guiding precision mHealth management in clinical practice.

Methods A systematic search was conducted in PubMed, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and other databases for randomized controlled trials (RCTs) on mHealth interventions in elderly hypertensive patients, from inception to March 31, 2025. Two researchers independently screened the literature, extracted data, and assessed methodological quality using the Cochrane Risk of Bias Tool. Meta-analysis was performed using RevMan5.4.

Results Thirty RCTs involving 4 286 participants were included. Compared with conventional management, mHealth significantly reduced systolic blood pressure (weighted mean difference WMD = −13.46, 95%CI: −17.12 to −9.80) and diastolic blood pressure (WMD = −7.07, 95%CI: −8.34 to −5.80), and improved blood pressure control rate (RR = 1.31, 95%CI: 1.24 to 1.38), and improved Morisky Medication Compliance Scale score (standardized mean difference SMD = 0.78, 95%CI: 0.55 to 1.02). Subgroup analyses further revealed that interventions with a duration of ≤ 3 months yielded superior blood pressure reductions; “Internet + ” multimodule integrated management showed greater effectiveness than single reminder-based approaches; and age-friendly functional features (including voice reminders, simplified interfaces) were associated with enhanced adherence and more favorable blood pressure outcomes.

Conclusions mHealth management effectively improves blood pressure control and medication adherence among elderly hypertensive patients, supporting the evidence-based implementation of digital health in chronic disease management for older adults. Given the limitations in methodological quality, quantity, and heterogeneity of included studies, more high-quality RCTs are warranted for further validation.