Objective To investigate the safety of the elderly patients with hypertension during analgesic gastroscopy by monitoring the changes of their vital signs and responses during operation process. Methods A total of 100 hypertension patients with age over 80 undergoing gastroscopy were prospectively divided into experimental group (receiving analgesic gastroscopy) and control group (receiving conventional gastroscopy), with 50 cases in each group. During the process of gastroscopy, the heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), saturation of blood oxygen (SaO2), operating time and adverse reaction were monitored and compared between the two groups. Results The HR, SBP, DBP, and SaO2 were decreased during analgesic gastroscopy (P＜0.01), and all of these indexes returned to normal levels after operation. The SBP, DBP, and HR were increased (P＜0.01) and SaO2 was decreased (P＜0.01) during conventional gastroscopy. The SaO2 was higher in analgesic gastroscopy group than in conventional gastroscopy group, but there was no significant difference between the two groups (P＞0.05). Analgesic gastroscopy group had shorter operating time than in conventional gastroscopy group, but there was no significant difference between the two groups (P＞0.05). Analgesic gastroscopy group had significantly fewer adverse reactions and were more comfortable during operation when compared with conventional gastroscopy group (both P＜0.01). Conclusion Analgesic gastroscopy is safe and comfortable for elderly patients with hypertension.