Objective To develop a precise blood pressure control scheme for patients with traumatic brain injury (TBI) combined with chest and abdominal injuries in the early stage, and to observe its application effect. Methods This study was a retrospective + prospective study with a single-centre two-stage design, retrospectively analyzed the clinical case data of patients with TBI combined with thoracic and abdominal injuries who visited our hospital from June 2020 to April 2023, and were included in the control group (n=61), and prospectively studied the patients with TBI combined with thoracic, and abdominal injuries who visited our hospital from May 2023 to February 2025, and were included in the precision group (n=59), and the control group was treated with conventional blood pressure management, and the precision group used an individualised blood pressure regulation program based on multimodal monitoring. Neurological function, haemodynamic indices, organ function (e. g. blood lactate, oxygenation index), complication rate and 6-month survival rate after 24 h, 72 h and 7 d of treatment were compared between the two groups. Results The precision group exhibited higher Glasgow Coma Scale scores than the conventional group at 72 hours and 7 days post-treatment. At 24 hours and 72 hours post-treatment, the precision group demonstrated more normalized levels of mean arterial pressure, heart rate, and cardiac index compared to the conventional group. Blood lactate levels were lower in the precision group at 24 hours, 72 hours, and 7 days post-treatment. The incidence of acute respiratory distress syndrome, secondary hemorrhage, and hypoperfusion-related cerebral ischemic events was lower in the precision group than in the control group. At 24 h, 72 h, and 7 d post-treatment, the precision group exhibited significantly higher mean intracranial pressure. Optimal cerebral perfusion pressure was higher in the precision group only at 7 d post-treatment. Patients in the precision group demonstrated significantly higher Glasgow Outcome Scale scores at discharge, 3 months, and 6 months post-treatment compared to the conventional group. Within 6 months, the precision group reported 3 cases of secondary epilepsy and 1 case of cognitive impairment. The long-term complication rate and readmission rate in the precision group were both 6.78% (4/59), significantly lower than the conventional group. The 6-month survival rate was 79.66% (47/59) in the precision group and 66.10% (39/61) in the conventional group, showing no statistically significant difference. Conclusion Precision blood pressure management in patients with traumatic brain injury (TBI) complicated by thoracic and abdominal injuries effectively balances cerebral perfusion with hemorrhagic risk, improves neurological function and 6-month outcomes, reduces the risk of ARDS and hypoperfusion-related cerebral ischemic events, maintains organ perfusion within reasonable ranges to some extent, and enhances short-term prognosis. However, it does not reduce the risk of long-term mortality.