Improving hypertension control is a public health priority and could reduce health disparities. Self blood pressure monitoring (SBPM) is effective but not widely integrated into clinical care. A pragmatic study distributing blood pressure (BP) monitors was conducted to assess its effectiveness in the management of uncontrolled hypertension under conditions consistent with clinic resources. Patients, predominantly black and Hispanic adults from clinics in low-income, medically underserved communities with uncontrolled BP were enrolled. Follow-up assessments were conducted 9 months after enrollment. Approximately half (53%) of the patients had controlled hypertension at follow-up. Systolic and diastolic BP decreased by 18.7 mm Hg and 8.5 mm Hg, respectively, at follow-up. Although attenuated, decreases persisted after adjustment for regression to the mean. Clinicians were supportive of the program, although collecting follow-up data from enrolled patients was a common challenge. The integration of SBPM into routine management of uncontrolled hypertension demonstrated substantial improvements in control. Systems to identify and track patients who are self-monitoring may increase impact. J Clin Hypertens (Greenwich). 2013;00:00–00. ©2013 Wiley Periodicals, Inc.