This paper investigates the cracking prevention and control of concrete engineering in ultra-high altitude areas. Combined with the hydration-temperature-humidity-constraint coupling model, the cracking risk assessment of bridge piers under extreme environment was carried out. The effect of deformation compensation crack control in concrete cracking risk control was revealed. Finally, the concrete cracking risk was assessed after long-term temperature changes. The results show that wind speed, air temperature, light, humidity and freeze–thaw greatly affect the cracking control of concrete. The cracking risk in the surface layer of the bridge piers is maximum around 2–4 days. The maximum cracking risk coefficient is between 0.6  and  0.95. And the risk of core cracking increases progressively after 14 days. When the HME-V® crack-resistant product is added, the unit expansion deformation of concrete increases during the temperature rise phase. Furthermore, the unit volume shrinkage is decreased during the temperature drop phase. A significant deformation compensation is produced. The risk of early and long-term cracking in the core and surface layers of the concrete structure is significantly reduced. The effect of crack control is remarkable. In summary, pre-cracking control in the surface layer of bridge piers is crucial. The risk of long-term cracking in the core is significantly higher than that in the early stage, and long-term cracking control should also be emphasized.