Endovascular ultrasound renal denervation (u-RDN) is a new, effective and non-pharmacological therapy for hypertensive patients with obstructive sleep apnea (OSA), requiring analgesia and sedation due to pain and discomfort. However, most OSA patients have difficult airways, and the selection of sedative and analgesic drugs is limited during u-RDN because drugs affecting sympathetic nerve activity need to avoid as much as possible. Appropriate anesthesia method can provide adequate analgesia and maintain stability of respiration and circulation, which is also related to better u-RDN results. Therefore, the anesthetic management of hypertensive patients with OSA during u-RDN is challenging and it is clinically important to explore best perioperative anesthesia strategy in the management of u-RDN procedure in these patients. We describe two cases of anesthesia management for hypertensive patients with severe OSA during u-RDN, which demonstrate that conscious analgesia based on remifentanil infusion combined with intermittent fentanyl bolus to enhance analgesia may improve hemodynamic stability, reduce the risk of respiratory depression and the need for airway support in hypertensive patients with OSA during u-RDN.