Aim To compare the effects of dexmedetomidine combined with sevoflurane versus remifentanil for general anesthesia on recovery quality in hypertensive patients undergoing laparoscopy. Methods Forty ASAⅠ-Ⅲ with hypertension undergoing laparoscopy patients were randomly divided into two gyoups: dexmedetomidine group and remifentanil group. Anesthesia was induced with midazolam 0.06 mg/kg, propofol 1.5 mg/kg and fentanyl 3 μg/kg. Tracheal intubation was facilitated with cis-atracurium 0.2 mg/kg. Anesthesia was maintained with 2%～4% sevoflurane and intermittent iv boluses of cis-atracurium 0.1 mg/kg. After induction of anesthesia, dexmedetomidine was infused at 0.5 μg/（kg·h） in dexmedetomidine group and remifentanil at 0.1 μg/（kg·min） in remifentanil group. Narcotrend index was maintained between 40～60. Dexmedetomidine were withdrawn 30 min before and remifentanil and sevoflurane were stopped 5 min before the end of surgery. Time of inspiration, eye opening, extubation and orientation as well as length of post-anaesthesia care unit （PACU） stay were recorded. Follow-up evaluations were performed to assess hemodynamic variables, the need for analgesics, and side effects. Results The time of eye opening, extubation and orientation as well as length of post-anaesthesia care unit stay were not significantly different in dexmedetomidine group than those in remifentanil group. However, SBP, DBP and HR in dexmedetomidine group during extubation and 1 min after extubation were significantly lower than those in Remifentanil group and three patients in dexmedetomidine group required opiods, less than that in remifentanil group. The percentages of patients suffering restlessness, shivering or postoperative nausea and vomiting were lower in dexmedetomidine group than those in remifentanil group. Conclusion The efficacy of dexmedetomidine combined with sevoflurane anesthesia is better than remifentanil combined with sevoflurane anesthesia in hypertensive patients undergoing laproscopy.