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Introduction: Hypertension (HTN) is a common risk factor for various medical diseases. Recently, there is growing evidence focusing on the potential inflammatory properties of food in the developing HTN risk. However, limited data are indicating the link between the dietary inflammatory index score (DII) and HTN risk. Aim: This study aimed to investigate the relationship between DII score and HTN risk in middle-aged people. Methods: This case-control study was performed on 945 middle-aged participants (376 subjects with HTN and 569 control group). Usual dietary intakes were collected using a validated semi-quantitative food frequency questionnaire. The dietary inflammatory index (DII) for each participant was calculated with a standardized procedure, and the relationship between the risk of HTN and the DII score was investigated. Results: The multi-adjusted regression analysis showed that subjects with the higher DII score had a 1.61 times greater chance of developing HTN than individuals in the lowest ones (95% CI 1.07–2.65). Interestingly, after conducting a sex-based analysis, there was no significant relationship between DII score and risk of HTN in middle-aged women (95% CI 0.38–1.61). However, middle-aged men in the highest quartile of DII had greater (2.91 times) odds of HTN compared to the lowest quarter of DII (95% CI 1.52–5.23). Conclusion: The findings of this study suggested that adherence to a diet with a high inflammatory index could increase the risk of HTN in middle-aged men by approximately 2.9 times. However, following a diet with a high DII score had no significant relationship with HTN risk in middle-aged women. [ABSTRACT FROM AUTHOR]