Objective To systematically review the benefits and risks of more intensive versus less intensive blood pressure control in Asian elderly patients over 60 years old. Methods The PubMed, EMbase, Cochrane Library, CNKI, WanFang Data, VIP and CBM databases were electronically searched to collect randomized controlled trials (RCTs) of intensive versus less blood pressure control from inception to August 2022. Two reviewers independently screened the literature, extracted data and evaluated the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 6 RCTs involving 20 701 patients were included. The results of meta-analysis showed that intensive blood pressure control could reduce the incidence of cardiovascular death, stroke, and heart failure. However, it could not reduce the incidence of all-cause death and myocardial infarction. Subgroup analysis showed that systolic blood pressure greater than 140 mmHg could not reduce the incidence of cardiovascular death. The safety evaluation found no increase in adverse events or renal injury in intensive blood pressure control group. Conclusion The current evidence shows that intensive blood pressure control can reduce the incidence of cardiovascular death, stroke and heart failure events in elderly Asian patients over 60 years old, but it has no effect on all-cause mortality and myocardial infarction events. It has good safety. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.