Low air pressure in plateau regions impacts the microstructure and macroscopic properties of cement-based materials by altering water transport. However, the efficiency of steam curing, a frequently-used curing approach, under these conditions has been inadequately studied. This work compares the effects of steam curing on the mechanical properties, drying shrinkage, and microstructure of cement-based materials at low air pressure. Results show that low air pressure decreases the compressive strength and increases the drying shrinkage of steam-cured mortar due to reduced hydration and increased total pore volume. Optimally, a steam curing temperature of 40°C to 60°C minimizes thermal damage, and a pre-curing time of 3 hours yields the best mechanical properties and drying shrinkage. Additionally, a field case confirms the effectiveness of the proposed steam curing regime; the demolding strength of precast beams meets engineering standards, and drying shrinkage fluctuates significantly with daily temperature changes. Notably, a 25.30 % difference in 90-day drying shrinkage between steam-cured and non-steam-cured specimens underscores the necessity of steam curing in high-altitude areas. These findings are crucial for optimizing steam curing practices in low-pressure environments.