Objective:To investigate the clinical efficacy of propofol on blood pressure (BP) and heart rate (HR) in hypertensive patients with hyperacute uncomplicated type B aortic dissection (HU-TBAD).Methods:This study was a single-center, double-blind, randomized controlled trial. Totally 96 consecutive hypertensive patients with HU-TBAD admitted to the Department of Emergency in our hospital from July 2020 to March 2023 were enrolled and randomly divided into control and treatment groups ( n=48/group) by envelope method. All patients were treated with nicardipine, remifentanil, esmolol, and basic treatments. Besides, patients in the treatment group were injected with 0.5 mg/kg propofol, followed by 1.0 mg/(kg·h) with continuous micro-pump intravenous infusion; the RASS score was evaluated every 15 minutes to adjust the dosage of propofol to maintain the RASS score at -2-0 points, while the control group was given an equal volume of normal saline. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR were analyzed at different time points (TPs). Related indexes between the two groups were compared at 0 (T 0 min) and 60 (T 60 min) minutes. Standard-reaching rate of related indexes, levels of mean nicardipine dose (mND) and urine volume, and adverse effect rates (AERs) were also compared between the two groups. All patients were admitted to the cardiovascular surgical ward to receive proper management and follow-up for 21 d after discharge from the Department of Emergency. Mann-Whitney U test, t-test, χ2 test, or Fisher's test were used to compare the data between the two groups, while the data of two groups at different TPs were compared by using repetitive measurement deviation analysis. Results:No significant differences were observed in general clinical data between the two groups (all P>0.05). There were significant differences in SBP, DBP, and HR levels in different TPs, groups, and interaction of Time and Group (Time×Group) (all P<0.05). For comparison of related indexes at T 0 min and T 60 min, there were statistical differences in oxygenation index levels at different TPs ( P<0.01), but not in different groups and Time×Group (all P>0.05); significant differences in levels of partial pressure of carbon dioxide, respiratory rate, and lactate were observed in different TPs and Time×Group (all P<0.01), but not observed in different groups (all P>0.05). There were significant differences in NRS score in different TPs, groups, and Time×Group (all P<0.05), while not in cardiac troponin I levels in different TPs, groups, and Time×Group (all P>0.05). Compared with the control group, the standard-reaching rate of SBP, DBP, HR, sedation, and analgesia as well as the level of RASS score reduction in the treatment group were significantly increased [54.17% vs. 77.08%, 56.25% vs. 81.25%, 50.00% vs. 72.92%, 47.92% vs. 72.92%, 43.75% vs. 83.33%, 1.00 (0, 2.00) vs. 2.00 (1.00, 3.00), respectively, all P<0.05], while the level of mND was significantly decreased [μg·kg -1·min -1, 2.50 (2.00, 2.50) vs. 2.00 (1.50, 2.50), P<0.01]; there were no statistical differences in both urine volume levels and AERs between the two groups (all P>0.05). Following up for 21 d, the rate of aortic dissection deterioration and ICU admission was significantly lower in the treatment group than in the control group (19.57% vs. 4.26%, 23.91% vs.6.38%, respectively, all P<0.05). Conclusions:Propofol enhances the analgesic effect of remifentanil, synergistically reduces SBP, DBP, and HR, and improves clinical prognosis in hypertensive patients with HU-TBAD.