OBJECTIVES To investigate carotid intima-media roughness (IMR) in hypertensive patients with normal carotid intima-media thickness (IMT) using automatic identification software and the correlation between carotid IMR and risk factors. METHODS This case-control study comprised 61 hypertensive patients with normal carotid IMT and 51 control participants. Carotid IMR, carotid IMT, pulsed wave velocity (PWV), stiffness (β), and arterial compliance were determined by carotid ultrasound and image postprocessing using an automatic identification program and echo-tracking analysis software. RESULTS Carotid IMR, mean carotid IMT, maximum carotid IMT, β, and PWV in the hypertension group were higher than those in the control group (58.24 versus 34.61 μm, 641.17 versus 576.48 μm, 746.82 versus 640.55 μm, 9.42 versus 7.35, and 7.10 versus 5.86 m/s, respectively; P