In this paper, we explore the almost Cohen-Macaulayness of the associated graded ring of stretched $\mathfrak{m}$-primary ideals with small first Hilbert coefficient in a Cohen-Macaulay local ring $(A, \mathfrak{m})$. In particular, we explore the structure of stretched $\mathfrak{m}$-primary ideals satisfying the equality $\mathrm{e}_1(I)=\mathrm{e}_0(I)-\ell_A(A/I)+4$, where $\mathrm{e}_0(I)$ and $\mathrm{e}_1(I)$ denote the multiplicity and the first Hilbert coefficient, respectively.