Blood pressure self-measurement (BPSM) requires patients to follow a range of recommendations in order to be considered reliable for diagnostic use. We investigated currently used BPSM interventions at four medical clinics combined with an online questionnaire targeting BPSM users. We found that the participating healthcare personnel perceived BPSM as a relevant and useful intervention method providing that the recommendations are followed. A total of six challenges were identified: (1) existing devices do not guarantee that the recommendations are followed, (2) healthcare providers cannot verify whether self-monitoring patients follow the recommendations, (3) patients are not aware of all recommendations and the need to follow them, (4) risk of patient induced reporting bias, (5) risk of healthcare provider induced data-transfer bias, and (6) risk of data being registered as belonging to the wrong patient. We conclude that existing BPSM interventions could be significantly affected by user-induced bias resulting in an indeterminable quality of the measurement data. Therefore, we suggest applying context-aware technological support tools to better detect and quantify user errors. This may allow us to develop solutions that could overcome or compensate for such errors in the future. 1. Background Hypertension is defined as elevated blood pressure (BP) above 140？mm Hg systolic and 90？mm Hg diastolic when measured under standardized conditions [1]. Hypertension can be a separate chronic medical condition estimated to be affecting a quarter of the world’s adult population [2], as well as a risk factor for other chronic and nonchronic patient groups. Traditional high-risk patient groups include diabetics, pregnant women with gestational diabetes or Preeclampsia, and kidney disease patients. For chronic hypertensive patients, persistent hypertension is one of the key risk factors for strokes, heart attacks, heart and kidney failure, and other heart and circulatory diseases and increased mortality [3]. Preeclampsia is the most common cause of maternal and fetal death [4]. For gestational diabetes and Preeclampsia patients, the accurate measurement of BP during pregnancy is one of the most important aspects of prenatal care. For kidney disease patients and diabetics, blood pressure should be kept below 130？mmHg systolic and 80？mm Hg diastolic to protect the kidneys from BP-induced damage [5]. As there are usually no symptoms, frequent blood pressure controls are highly relevant for these high-risk groups. The level of the blood pressure is the main factor in
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