Highly efficient heat exchange tubes are special tube shapes that are widely used in heat exchangers to enhance heat transfer. In this study, experimental measurements and numerical simulations were carried out on two types of highly efficient heat exchange tubes, namely, spirally grooved tubes and converging–diverging tubes, to investigate changes in their mechanical properties after rolling from smooth tubes. It was found that, unlike the smooth tubes, all axial, circumferential, and radial stresses exist at the two types of tubes under axial loading, and the maximum axial stress is much larger than that at the smooth tubes. Compared to the smooth tubes, the yield strength and ultimate strength of the highly efficient heat exchange tubes increase while the axial elastic stiffness decreases. Although the capability of resisting fatigue fracture of the highly efficient heat exchange tubes is less than that of smooth tubes, they still meet the requirements of the heat exchanger under fatigue loading. Axial stress concentration factors and stiffness equivalent factors for the highly efficient heat exchange tubes are regressed as a function of the structural parameters for engineering applications.