PURPOSE: This study aimed to investigate the association between the pan-immune-inflammation value (PIV) and dipper/non-dipper status in newly diagnosed hypertensive (HT) patients. Given the role of systemic inflammation in circadian blood pressure (BP) pattern, we hypothesized that elevated PIV levels would be linked to an impaired nocturnal BP decline. PATIENTS AND METHODS: A total of 725 newly diagnosed hypertensive patients and 343 normotensive controls were prospectively included in the study. The HT patients were further classified as dipper (n=339) or non-dipper (n=386) based on 24-hour ambulatory BP monitoring (ABPM). PIV was calculated as (neutrophil count × platelet count × monocyte count) / lymphocyte count. Multivariate logistic regression analysis was performed to assess the independent association between PIV quartiles and non-dipper status. Receiver operating characteristic (ROC) curve analysis was conducted to determine the predictive value of PIV. RESULTS: PIV was significantly higher in non-dipper hypertensive patients compared with dipper hypertensive patients (p<
0.002). In multivariate regression models adjusted for age, sex, body mass index (BMI), smoking, diabetes mellitus, and echocardiographic parameters, the highest PIV quartile (Q4) was independently associated with non-dipper status (OR: 12.56, 95% CI: 7.31-21.56, p<
0.002). ROC analysis demonstrated that a PIV cutoff of 326.96 predicted non-dipper status with a sensitivity of 70.5% and specificity of 65.5% (AUC: 0.725, p<
0.002). CONCLUSION: Elevated PIV levels were significantly associated with non-dipper hypertension, reinforcing the contribution of systemic inflammation to circadian BP dysregulation. These findings suggest that PIV may serve as a potential biomarker for risk stratification and personalized treatment approaches in hypertensive patients.