Background: Hypertension is an important risk factor for carotid atherosclerotic disease. Ultrasonography with Doppler provides non-invasive assessment of carotid arterial wall changes, plaque characteristics and blood-flow parameters. This study evaluated carotid artery changes in hypertensive patients using ultrasonography and Doppler. Methods: This cross-sectional observational study included 104 hypertensive patients. Bilateral carotid arteries were examined using grayscale, colour and spectral Doppler ultrasonography. Common carotid artery intima–media thickness (CCA-IMT), peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), plaque presence and morphology, and degree of stenosis were assessed. Associations with demographic and clinical characteristics were analysed. Receiver operating characteristic analysis was performed to assess the diagnostic performance of Doppler parameters. Results: The mean age was 52.66 ± 15.05 years, and 56.7% were females. Carotid plaques were detected in 49 patients (47.1%). Plaque presence was significantly associated with age (p=0.048), but not with gender, hypertension stage or duration. Hyperechoic and hypoechoic plaques were the commonest patterns (32.7% each). Plaque morphology was significantly associated with age (p=0.017), gender (p=0.034) and hypertension stage (p=0.003). Mild stenosis was observed in 73.5% and moderate stenosis in 26.5% of plaque-positive patients; no severe stenosis or occlusion was identified. CCA-IMT, CCA EDV and ICA PSV differed significantly across plaque morphologies. CCA PSV had the highest area under the curve (AUC) for plaque detection (0.632). For moderate stenosis, CCA PSV and ICA PSV showed AUCs of 0.736 and 0.714, respectively. Conclusion: Carotid ultrasonography and Doppler demonstrated a considerable prevalence of carotid plaques in hypertensive patients. Combined assessment of arterial wall thickness, plaque morphology and Doppler velocities may help characteri