Study regionThe urban agglomeration in the middle reaches of the Yangtze River (MRUA) consisting of 31 cities is a pillar of the Yangtze River Economic Belt and the largest urban agglomeration in China, densely populated, and rapidly urbanizing. Study focusExtreme precipitation events are affected by rapidly urbanized regions with uneven levels of urbanization. Hence, it is important to explore the spatiotemporal evolution of extreme precipitation in urban agglomerations and the influence of the spatially uneven development of urban areas under rapid large-scale urbanization. New hydrological insights for the regionExtreme precipitation indices (Pmax1d, R20, and PF95) exhibited significant positive trends during 1979–2018 in the MRUA, increasing by 0.43 mm/year, 0.11 day/year, and 2.46 mm/year, respectively. Regression models based on raster urbanization data were constructed, and the impervious area ratio (IA) and landscape shape index (SI) were shown to be the dominant urbanization factors affecting regional extreme precipitation, with a particularly positive spatial correlation with PF95 and Pmax1d at all stages of urbanization. Moreover, the urban-rural comparison results revealed that the difference in SI of each city was positively correlated with the urban heat island intensity. In the three provincial capitals, Pmax1d and R50 were greater in urban centres than in rural areas. This study contributes to a comprehensive understanding in the variability of extreme precipitation events under the influence of large-scale urbanization.