OBJECTIVE： To observe the effects of different doses of dexmedetomidine on tracheal intubation stress response in elderly patients with hypertension. METHODS： A total of 105 elderly hypertensive patients who underwent selective general anesthesia with tracheal intubation were selected from our hospital during Jun. 2014-May 2016， and then divided into group A， B， C according to random number table， with 35 cases in each group. Three groups received general anesthesia， Dexmedetomidine injection 0.3， 0.6， 1.0 μg/kg by intravenous infusion and Remifentanil injection 0.5 μg/kg 15 min before intubation. After 10 min of administration， 3 groups stopped drug infusion and received tracheal intubation fiberoptic bronchoscope. Mean arterial pressure （MAP）， heart rate （HR）， blood pulse oxygen saturation （SpO2）， respiratory rate （RR） were observed in 3 groups at 5 min after entering surgery room （T1）， immediately after infusion （T2）， immediately after intubation （T3）， 1 min after intubation （T4）， 5 min after intubation （T5）. Ramsay sedation scores， cough scores and intubation tolerance scores were also recorded in 3 groups at T3， and the occurrence of ADR was compared among 3 groups. RESULTS： At T1， there was no statistical significance in MAP， HR， SpO2 or RR among 3 groups （P＞0.05）. At T2， above indexes of 3 groups were decreased significantly than at T1， with statistical significance （P＜0.05）； there was no statistical significance among 3 groups （P＞0.05）. At T3， T4 and T5， MAP， HR， SpO2 and RR of 3 groups were increased significantly than at T2， and MAP and HR of group A were significantly higher than those of group B and C， with statistical significance （P＜0.05）. There was no statistical significance in SpO2 or RR among 3 groups （P＞0.05）. At T3， Ramsay sedation scores， cough scores， intubation tolerance scores of group B and C were significantly higher than those of group A， with statistical significance （P＜0.05）. The incidence of hypertension， tachycardia， cough and restlessness in group A were significantly higher than group B and C （P＜0.05）， the incidence of bradycardia and respiratory depression in group C were significantly higher than group A and B， with statistical significance （P＜0.05）. CONCLUSIONS： Dexmedetomidine 0.6 μg/kg and 1.0 μg/kg can effectively inhibit stress response and maintain hemodynamics stable in elderly hypertensive patients during tracheal intubation， and dexmedetomidine 0.6 μg/kg has relatively lower incidence of ADR.