Objective To explore the diagnostic value of CT pulmonary artery imaging for chronic obstructive pulmonary disease (COPD) complicated with pulmonary hypertension. Methods 80 cases of patients with COPD and pulmonary hypertension who were admitted to the hospital from April 2016 to April 2018 were selected and given CT pulmonary artery imaging. According to the pulmonary systolic pressure measured by ultrasonic cardiogram, the patients were divided into mild-to-moderate group (53 cases) and severe group (27 cases). The main pulmonary artery diameter (MPAD), right pulmonary aortic diameter (RPAD) and left pulmonary aortic diameter (LPAD) were measured, and the ROC curve was used to analyze the values of MPAD, RPAD and LPAD in assessing COPD with pulmonary hypertension. And the pulmonary exudative lesions and pleural effusion were observed. Results The MPAD, RPAD and LPAD in severe group were greater than those in mild-to-moderate group (P<0.05). The incidence rates of pulmonary exudative lesions and pleural effusion in severe group were higher than those in mild-to-moderate group (P<0.05). ROC curve analysis showed that the sensitivity of MPAD for severe pulmonary hypertension was higher than that for mild-to-moderate pulmonary hypertension (P<0.05). Conclusion Measurement of MPAD, RPAD and LPAD by CT pulmonary artery imaging can observe the pulmonary exudative lesions and pleural effusion, and can have early detection of COPD with pulmonary hypertension, and it has a certain help for pulmonary hypertension classification, and it has important diagnostic value.