Abstract
Bullous pemphigoid (BP) is a chronic, autoimmune skin disorder characterized by subepidermal blistering in various regions of the body. Blister formation is caused by the production of autoantibodies to hemidesmosomal BP antigen 1 (BP230) and BP antigen 2 (BP180). Observational studies have suggested a possible association between BP and hypertension, with hypertension reported as the most frequent comorbidity in BP patients in several studies. We conducted a systematic review and meta-analysis to better elucidate the relationship between BP and hypertension. Ovid MEDLINE, Embase, Web of Science, and Cochrane databases were searched for clinical studies on bullous pemphigoid patients with hypertension, from inception to February 28, 2021. PRISMA guidelines were followed. 11 case-control studies were included in the meta-analysis, with a total of 71,812,699 study participants. Among them, 22,814 were patients with BP. The mean ages of BP patients and controls were 75.4 and 76.1, respectively. The proportion of females among the BP group was 49.9%. Using random effects modeling, the odds ratio (OR) for hypertension in patients with BP was found to be significant when compared with controls (OR=1.28 [95% confidence interval (CI) 1.04-1.56]. Subgroup analyses showed a significant association between BP and hypertension in studies with greater than 1000 BP cases (OR=1.56 [95% CI 1.19-2.04]). Whereas no association between BP and hypertension was observed among studies conducted in Europe (OR=0.94 [95% CI 0.52-1.68]), significant associations were found among studies conducted in Asian countries (OR=1.31 [95% CI 1.09-1.58]) and the United States (OR=1.96 [95% CI 1.90-2.03]). These findings suggest that BP is significantly associated with hypertension. Patients with BP may need to be closely monitored for comorbid hypertension. Despite our effort to not select papers that bias the data, there could still be bias in the selection process.
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