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Background: Hypertension is one of the leading causes of death worldwide, yet despite this disease being a known public health challenge, fewer than a third of patients with hypertension achieve blood-pressure control. In this study, we describe an easy to use and affordable home blood-pressure telemonitoring system —Kuska Tele-Wasi, from the Quechuan words for “working together” and “home”. We aimed to compare hypertension control in patients using this blood-pressure telemonitoring system with that in a control group. Methods: We recruited adult patients with hypertension from a primary health-care centre in Lima, Peru, to participate in our study. We included participants with uncontrolled blood pressure and who were taking pharmacological treatment for hypertension. Participants were randomly allocated to either an intervention group or control group. Patients in the intervention group used a home blood pressure telemonitoring device that sends readings via short messaging service (SMS) to primary care centres for health providers to use for decisions about treatment, office visits, and follow-up. Patients in the intervention group used the system for 2 weeks and were followed up for 2 more weeks at the primary care centre. In the control group, patients continued with the usual monitoring (clinic visits or patient-initiated monitoring at pharmacies) for 4 weeks. Primary outcome was the change in systolic and diastolic blood pressure from baseline to the end of the study period. The trial is registered at ClinicalTrials.gov (NCT03524456). Findings: We included data from 19 patients in the intervention group and 19 in the control group; 26 were women and the mean age was 68·1 years (SD 10·8). There was a difference in the change of systolic blood pressure values between the control and intervention group (–7·2 mm Hg [SD 14·9] vs −16·3 mm Hg [16·7]; p=0·09, respectively), and a difference in the change of diastolic blood pressure values (–1·2 mm Hg [6·4] vs −7·2 mm Hg [9·8]; p=0·03, respectively). Interpretation: A home blood pressure telemonitoring system based on SMS is effective in reducing blood pressure by working in conjunction with primary care centres. Our findings show that an intervention of this type can work in primary health care centres in an upper-middle income country, and could be an important strategy for the control of arterial hypertension. Funding: Runachay: Information and Communication Technologies for Global Health (NIH: 1R25TW009710-01) Masters Program in Biomedical Informatics in Global Health Thesis Funding (UPCH-FondeCyT).