BACKGROUND Hypertensive patients are more prone to exhibit an exaggerated hemodynamic responses to laryngoscopy and tracheal intubation. We compared the effects of remifentanil and lidocaine on the cardiovascular responses during intubation in hypertensive patients. METHODS Fifty adult hypertensive patients (>140/90 mmHg) were divided into 2 groups (remifentanil group; 1.0 microgram/kg, n = 25, lidocaine group; 1.5 mg/kg, n = 25). After 3 minutes'oxygenation, anesthesia was induced using 0.2 mg glycopyrrolate, 1.5 mg/kg propofol, and 1 of experimental drugs (30 seconds) bolus administration. Tracheal intubation was facilitated 90 seconds after administration of rocuronium; anesthesia was maintained with 2% sevoflurane and air in oxygen. Arterial blood pressure and heart rate were measured at the following times: resting state (baseline), after oxygenation; before intubation; just after intubation; and at 1, 3, and 5 minutes after intubation. RESULTS There was significant attenuation of mean systolic and diastolic arterial blood pressures, after intubation of the remifentanil group compared to the lidocaine group at just after intubation and at 1 minute after intubation (P < .05). The difference in heart rate was not significant between both groups. CONCLUSIONS Bolus administration of remifentanil was found to be superior to lidocaine in the attenuation of the blood pressure during intubation in hypertensive patients.