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Context Blood flow-restricted resistance exercise (BFR-RE) is used to elicit hypertrophy and strength adaptations with low external loads, making it attractive for clinical and rehabilitative populations. However, concerns regarding exaggerated cardiovascular responses highlight the need to clarify haemodynamic effects before broader clinical adoption.Objectives To compare acute cardiovascular responses—systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR)—during low-intensity BFR-RE (LI-BFR), low-intensity resistance exercise (LI-RE) and high-intensity resistance exercise (HI-RE).Data sources MEDLINE, EMBASE, ResearchGate, Web of Science and Cochrane Library were searched through February 2025. Randomised controlled trials comparing SBP, DBP and HR during LI-BFR versus LI-RE and/or HI-RE in healthy adults were included.Data synthesis Four trials for LI-BFR versus LI-RE (n=86) and three for LI-BFR versus HI-RE (n=46) were identified, with six reports eligible for random-effects meta-analyses adjusted for muscle and age. SBP (MD=14.06 mm Hg; 95% CI (0.24 to 27.90) and DBP (MD=11.18 mm Hg; 95% CI (2.8 to 19.57)) were significantly increased during LI-BFR versus LI-RE, while HR was not significant (MD=6.00 bpm; 95% CI (–5.47 to 17.5)). HI-RE and LI-BFR did not differ in effects on SBP (MD=0.53 mm Hg; 95% CI (–15.21 to 16.28)), DBP (MD=2.54 mm Hg; 95% CI(–5.59 to 10.67)) or HR (MD=–5.90 bpm; 95% CI (–12.55 to 0.74)). However, risk of bias and certainty of evidence analyses presented some concerns of bias and low to moderate certainty.Conclusion Arterial blood pressure is exaggerated during LI-BFR when compared with LI-RE. Data on real-time cardiovascular responses during BFR-RE are limited; therefore, future studies should be designed to measure haemodynamic parameters during exercise accurately.PROSPERO registration number CRD42025633694