Background <p>Hypertension, affecting over 1.3&#xa0;billion people globally, poses a significant public health challenge. Despite its widespread impact, hypertension management in primary healthcare settings faces challenges such as fragmented data collection, low patient adherence, and insufficient real-time monitoring. This study evaluates the effectiveness, cost-effectiveness, and implementation process of an Internet of Things (IoT)-based hypertension surveillance system designed to address these gaps in community health settings.</p> Methods <p>This pragmatic quasi-experimental trial involves 2,000 hypertensive patients managed under family doctor contract services in Beijing, China. The intervention group (<i>n</i> = 1,000) utilizes an IoT-based hypertension monitoring platform, which integrates smart blood pressure devices and real-time data transmission for dynamic tracking and management. The control group (<i>n</i> = 1,000) receives standard care without IoT integration. The primary outcome is blood pressure control rate, while secondary outcomes encompass standardized management rate, measurement completion rate, referral rates and biomarker profiles. Cost-effectiveness is evaluated using administrative data on healthcare utilization and intervention costs. Qualitative data, collected through patient surveys and focus groups with healthcare providers, explores implementation barriers and user experiences.</p> Discussion <p>The study aims to provide comprehensive evidence on the clinical effectiveness, cost-effectiveness, and implementation process of IoT-based hypertension management in primary care. By combining quantitative and qualitative methods, it seeks to understand how the intervention works in real-world settings and identify facilitators and barriers to its implementation. The findings could inform policy decisions and optimize resource allocation for chronic disease management in primary care.</p> Trial registration <p>ChiCTR, ChiCTR2500103556.Registered 30 May 2025.</p>