The certainty of evidence was moderate for SBP and HR, and low for DBP. High‐dose alcohol within 7 to 12 hours of consumption (3 RCTs, N = 54) decreased SBP by 3.7 mmHg (95% CI ‐7.0 to ‐0.5) and DBP by 1.7 mmHg (95% CI –4.6 to 1.8) and increased HR by 6.2 bpm (95% CI 3.0 to 9.3). High‐dose alcohol (> 30 g) within six hours (16 RCTs, N = 418) decreased SBP by 3.5 mmHg (95% CI ‐6.0 to ‐1.0), decreased DBP by 1.9 mmHg (95% CI‐3.9 to 0.04), and increased HR by 5.8 bpm (95% CI 4.0 to 7.5). The certainty of evidence was moderate for SBP and HR, and was low for DBP. Low‐dose alcohol ( 13 hours after consumption (4 RCTs, N = 66) did not affect BP or HR. The mean age of participants was 33 years, and mean body weight was 78 kilograms. We included 32 RCTs involving 767 participants. Most of the study participants were male (N = 642) and were healthy.