BACKGROUND: Echo-tracking (ET) technology can visually determine whether vascular endothelial function is impaired. However, it remains uncertain whether routine ET testing for pregnant women could effectively diagnose pregnancy concurrent with hypertension (PCH) based on changes in vascular elasticity. METHODS: An ET ultrasound system was employed to assess the elasticity of the carotid artery. The plasma nitric oxide (NO) levels were determined using radioimmunoassay, and the levels of endothelin-1 (ET-1) were determined using an enzyme-linked immunosorbent assay. The prediction of PCH occurrence was assessed using receiver-operating characteristic curve analysis. The correlation between the two factors was evaluated using regression analysis. RESULTS: Pregnant women with PCH display significant differences in systolic blood pressure, diastolic blood pressure, and proteinuria compared to those with normal pregnancies. ET parameters, such as pulse wave velocity β (PWVβ), β-stiffness, pressure-strain elastic modulus (Eρ), and arterial compliance (AC), also reveal significant variances between women with PCH and those with normal pregnancies. These four factors are strongly associated with the disease progression in women with PCH and serve as reliable predictors for the occurrence of PCH. Additionally, the ET-1 level increases, while the NO level decreases in women with PCH, having the ability to predict the occurrence of PCH. Carotid endothelial elasticity decreases, and carotid endothelial function is impaired in pregnant women with PCH. CONCLUSION: The ET parameters and indexes of carotid endothelial function can reliably predict the occurrence of PCH.