Objective To analyze the traditional Chineses medicine (TCM) syndrome distribution and echocardiographic characteristics of patients with pulmonary hypertension caused by chronic obstructive pulmonary disease (COPD). Methods A retrospective analysis was performed on the case data of 287 patients with COPD admitted to the hospital from July 2024 to June 2025. Patients were grouped according to whether they had pulmonary hypertension.172 patients with pulmonary hypertension caused by COPD were included in group A, and 115 patients with simple COPD were set as group B. The TCM syndrome types of patients in group A were observed, and the related echocardiographic parameters [right ventricular end-diastolic diameter (RV-bDD), right ventricular middle end-diastolic diameter (RV-mDD), right ventricular free end-diastolic thickness (RVDT), right ventricular end-systolic area (RVESA), right ventricular end-diastolic area (RVEDA), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (FAC), right ventricular myocardial performance index (RIMP) main pulmonary artery diameter (MPA), tricuspid regurgitation peak velocity (TRV), right ventricular systolic pressure (RVSP)] were compared between the two groups of patients. Logistic multivariate analysis was used to analyze the influencing factors of pulmonary hypertension caused by COPD, and receiver operating characteristic (ROC) curve was drawn to analyze the diagnostic value of echocardiographic indicators in patients with pulmonary hypertension caused by COPD with different TCM syndromes types. Results Among the 172 patients with pulmonary hypertension caused by COPD, there were 54 cases (31.40%) of qi deficiency and blood stasis syndrome, 42 cases (24.42%) of phlegm and blood stasis obstructing lung syndrome, 32 cases (18.60%) of phlegm turbidity obstructing lung syndrome, 21 cases (12.21%) of lung-kidney qi deficiency syndrome, 16 cases (9.30%) of phlegm-heat obstructing lung syndrome and 7 cases (4.07%) of spleen-lung qi deficiency syndrome. Compared with group B, group A had higher MPA, TRV, RVSP, RV-bDD, RV-mDD, RVDT, RVESA, RVEDA and RIMP and lower TAPSE and FAC. Logistic multivariate analysis showed that high levels of echocardiographic indicators such as MPA, TRV, RVSP, RV-bDD, RV-mDD, RVDT, RVESA, RVEDA and RIMP were risk factors of pulmonary hypertension caused by COPD, and high levels of TAPSE and FAC were protective factors of pulmonary hypertension caused by COPD. Among patients with pulmonary hypertension caused by COPD, patients with phlegm and blood stasis obstructing lung syndrome showed significantly lower TRV and RVSP than patients with qi deficiency and blood stasis syndrome. There were no significant differences in TRV and RVSP between patients with other syndromes and patients with qi deficiency and blood stasis syndrome. ROC curve analysis showed that the areas under the ROC curves (AUC) of TRV and RVSP in the diagnosis of qi deficiency and phlegm turbidity obstructing lung syndrome. in patients with pulmonary hypertension caused by COPD were 0.627 and 0.686 respectively. Conclusion Among the patients with pulmonary hypertension caused by COPD, the proportion of qi deficiency and blood stasis syndrome is the highest, and the proportion of spleen-lung qi deficiency syndrome is the lowest, and the right ventricular function of patients is significantly decreased. Echocardiography can noninvasively and accurately evaluate the right ventricular function in patients. The related parameters of echocardiography can indicate the risk of pulmonary hypertension, and have certain diagnostic value for the two TCM syndromes types of qi deficiency and blood stasis syndrome and phlegm turbidity obstructing lung syndrome.