Supplemental Digital Content is available in the text. Heart failure (HF), hypertension, and abnormal nocturnal blood pressure dipping are highly prevalent in hemodialysis patients. Atrial fibrillation (AF) and HF might be important mediators for the association of abnormal dipping patterns with worse prognosis. Thus, the aim of this study is to investigate the association of dipping with mortality in hemodialysis patients and to assess the influence of AF and HF. In total, 525 hemodialysis patients underwent 24-hour ambulatory blood pressure monitoring. All-cause and cardiovascular mortality served as end points. Patients were categorized according to their systolic dipping pattern (dipper, nondipper, and reverse dipper). Cox regression analysis was performed to determine the association between dipping pattern and study end points with dipping as reference. Subgroup analysis was performed for patients with and without AF or HF. In total, 185 patients with AF or HF and 340 patients without AF or HF were included. During a median follow-up of 37.8 months, 177 patients died; 81 from cardiovascular causes. Nondipping and reverse dipping were significantly associated with all-cause mortality in the whole cohort (nondipper: hazard ratio, 1.95 [1.22–3.14]; P=0.006; reverse dipper: hazard ratio, 2.31 [1.42–3.76]; P<0.001) and in patients without AF or HF (nondipper: hazard ratio, 2.78 [1.16–6.66]; P=0.02; reverse dipper: hazard ratio, 4.48 [1.87–10.71]; P<0.001) but not in patients with AF or HF. For cardiovascular mortality, associations were again significant in patients without AF or HF and in the whole cohort. The observed associations remained significant after adjustment for possible confounders. This study provides well-powered evidence for the association between abnormal dipping patterns and mortality in hemodialysis patients and suggests that HF or AF modifies this association.

中文翻译：

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心力衰竭和心房颤动改变了血液透析患者夜间血压下降模式与死亡率的关联

补充数字内容在文本中可用。心力衰竭 (HF)、高血压和夜间血压下降异常在血液透析患者中​​非常普遍。心房颤动 (AF) 和 HF 可能是异常倾斜模式与较差预后相关联的重要介质。因此，本研究的目的是调查浸渍液与血液透析患者死亡率的关系，并评估 AF 和 HF 的影响。总共有 525 名血液透析患者接受了 24 小时动态血压监测。全因死亡率和心血管死亡率作为终点。患者根据他们的收缩期浸渍模式（杓状、非杓状和反杓状）进行分类。进行 Cox 回归分析以确定浸渍模式和研究终点之间的关联，以浸渍作为参考。对有和没有 AF 或 HF 的患者进行亚组分析。总共包括 185 名 AF 或 HF 患者和 340 名无 AF 或 HF 患者。在中位随访 37.8 个月期间，177 名患者死亡；81 来自心血管原因。在整个队列中，非浸渍和反向浸渍与全因死亡率显着相关（非浸渍型：风险比，1.95 [1.22–3.14]；P=0.006；反向浸渍型：风险比，2.31 [1.42–3.76]；P<0.001）在没有 AF 或 HF 的患者中（非杓型：危险比，2.78 [1.16–6.66]；P=0.02；反杓型：危险比，4.48 [1.87–10.71]；P<0.001），但在 AF 或 HF 患者中没有。对于心血管死亡率，在没有 AF 或 HF 的患者和整个队列中，这种关联再次显着。在调整可能的混杂因素后，观察到的关联仍然显着。这项研究为血液透析患者的异常浸渍模式与死亡率之间的关联提供了强有力的证据，并表明 HF 或 AF 改变了这种关联。