BACKGROUND: Abnormal nocturnal blood pressure patterns are associated with subclinical cardiac dysfunction in hypertension (HT). However, their relationship with the myocardial performance index (MPI) is not well-defined. METHODS: This retrospective study included 196 hypertensive patients who underwent 24-h ambulatory blood pressure monitoring (ABPM). Patients were classified as dipper, non-dipper, and reverse dipper according to nocturnal systolic blood pressure variation. Echocardiographic parameters, including MPI, were compared. Multivariate linear regression analysis was performed. RESULTS: The highest MPI values were found in the reverse dipper group (p < 0.001). Reverse dipper (B = 0.054, p < 0.001) and non-dipper (B = 0.023, p = 0.002) patterns were independently associated with increased MPI. MPI showed moderate discriminatory power in predicting the reverse dipper pattern (area under the curve [AUC] = 0.693). CONCLUSION: Reverse dipper and non-dipper patterns are associated with increased MPI. This finding suggests an association between abnormal circadian blood pressure patterns and subclinical cardiac dysfunction. Further prospective studies are required to determine clinical relevance.