Objective: To explore the clinical value of multimodal ultrasound in the diagnosis of carotid atherosclerotic plaque in patients with hypertension and hyperhomocysteinemia. Methods: We selected 120 patients with hypertension and hyperhomocysteinemia who had carotid atherosclerotic plaques under routine ultrasound examination in our hospital from May 2019 to June 2021. All patients underwent conventional ultrasound and contrast-enhanced ultrasound (CEUS) and elastography (EI) examination before surgery. Taking pathological results as the gold standard, according to the stability of plaques, they were divided into unstable plaque group (64 cases) and stable plaque group (56 cases). Compared the differences in the characteristics of different ultrasound examinations between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the effectiveness of conventional ultrasound, CEUS and EI alone or in combination in diagnosing unstable plaque.Results: In the unstable plaque group, the proportion of the number of people with severe stenosis and complete occlusion, irregular surface, calcified nodules and hypoechoic areas, enhancement degree (grade Ⅲ, Ⅳ), and the plaque thickness and elasticity score were significantly higher than those in the stable plaque group (P<0.05), the strain rate of the unstable plaque group was significantly lower than that of the stable plaque group (P<0.05). The area under the curve of carotid atherosclerotic plaques in patients with hypertension and hyperhomocysteinemia diagnosed as unstable plaques by conventional ultrasound, CEUS and EI The values are all higher than the above-mentioned inspection methods used alone. Conclusion: Multimodal ultrasound has a certain value in the differential diagnosis of the stability of carotid atherosclerotic plaque in patients with hypertension and hyperhomocysteinemia, and helps to improve the diagnostic coincidence rate of the disease.