Background <p>Sitagliptin, a dipeptidyl peptidase-4 inhibitors (DPP-4i), was commonly used as the hypoglycaemic agent, while the impact on blood pressure (BP) in type 2 diabetes mellitus (T2DM) remained unknown. The present study aimed to evaluate the effects of sitagliptin therapy on modulating systolic BP (SBP) and diastolic BP (DBP) in T2DM.</p> Methods <p>A systematic search of PubMed, Embase, and the Cochrane Library was conducted for randomized controlled trials (RCTs) examining the impact of sitagliptin on SBP and DBP in T2DM. Given to the inherent clinical heterogeneity, a random-effect model was used for the overall meta-analysis. Publication bias and sensitivity analysis were conducted using standard methods.</p> Results <p>A total of 24 studies were identified. Treatment with sitagliptin was associated with a reduction in SBP (WMD = −&#xa0;2.57&#xa0;mmHg, 95% CI −&#xa0;4.40 to −&#xa0;0.75; <i>I</i>^<i>2</i> = 0%; P = 0.006) and DBP (WMD = −&#xa0;1.09&#xa0;mmHg, 95% CI −&#xa0;2.16 to −&#xa0;0.03; <i>I</i>^<i>2</i> = 0%; <i>P</i> = 0.04) compared to placebo in patients with T2DM. Exploratory subgroup analysis suggested a potential trend toward BP reduction according to the subgroup analysis on treatment duration, BMI, HbA1c and dosage. The leave-one-out sensitivity analysis supported the robustness of these pooled effects. No significant publication bias was observed in BP parameters across the RCTs according to Begg’s and Egger’s tests.</p> Conclusions <p>Administration of sitagliptin was associated with a reduction of BP in patients with T2DM. However, its clinical role remained primarily glycemic control. The potential reduction of BP might be considered an ancillary benefit rather than a substitute for standard antihypertensive therapy.</p> <p>International prospective register for systematic review (PROSPERO) number: CRD42026128657.</p>