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Association between bullous pemphigoid and hypertension: a systematic review and meta-analysis of observational studies

Journal of Human Hypertension volume 39, pages 666–674 (2025)Cite this article

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Abstract

Studies have indicated a relationship between bullous pemphigoid (BP) and hypertension, but the findings remain controversial. To examine this association, we conducted a systematic review using studies from PubMed, EMBASE, Web of Science, and the Cochrane Library, applying a random-effects model while performing subgroup and sensitivity analyses to explore potential sources of heterogeneity. Subgroup analyses were performed by country, data source, and sample size. The quality of evidence was evaluated using the Newcastle-Ottawa Scale. The review protocol was registered in PROSPERO (ID: CRD42024573911). The analysis included 20 studies, primarily consisting of case-control studies from Europe and Asia, encompassing 72,981,822 participants, of whom 29,199 had BP. The mean ages of the BP group and the non-BP group were 74.62 and 74.25 years, respectively. Random-effects meta-analysis demonstrated a significant association between BP and hypertension (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.07–1.20). Subgroup analyses revealed stronger associations in database studies (OR = 1.24, 95% CI: 1.17–1.31) and in studies with over 1000 BP cases (OR = 1.30, 95% CI: 1.23–1.37). No significant association was observed in studies conducted in Asia (OR = 1.05) or Europe (OR = 1.07). However, a significant relationship was found in studies from the United States (OR = 1.29, 95% CI: 1.12–1.48). This study found a significant correlation between BP and hypertension, particularly in the United States. However, as most included studies were observational in nature, causality cannot be inferred. Further research is needed to elucidate the underlying mechanisms and causal relationship between BP and hypertension.

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Fig. 1: Literature screening flowchart (PRISMA process).
Fig. 2: Forest plot of random-effects model meta-analysis for the association between BP and hypertension.
Fig. 3: Subgroup analysis by country.
Fig. 4: Forest plot of subgroup analysis by data source (random-effects model).
Fig. 5: Forest plot of subgroup analysis by BP cases (random-effects model).
Fig. 6: Funnel plot for publication bias.

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Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

References

  1. Persson MSM, Harman KE, Vinogradova Y, Langan SM, Hippisley-Cox J, Thomas KS, et al. Incidence, prevalence and mortality of bullous pemphigoid in England 1998-2017: a population-based cohort study. Br J Dermatol. 2021;184:68–77. https://doi.org/10.1111/bjd.19022

    Article  PubMed  CAS  Google Scholar 

  2. Williams HC, Wojnarowska F, Kirtschig G, Mason J, Godec TR, Schmidt E, et al. Doxycycline versus prednisolone as an initial treatment strategy for bullous pemphigoid: a pragmatic, non-inferiority, randomised controlled trial. Lancet. 2017;389:1630–8. https://doi.org/10.1016/s0140-6736(17)30560-3

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Lee S, Rastogi S, Hsu DY, Nardone B, Silverberg JI. Association of bullous pemphigoid and comorbid health conditions: a case-control study. Arch Dermatol Res. 2021;313:327–32. https://doi.org/10.1007/s00403-020-02100-2

    Article  PubMed  CAS  Google Scholar 

  4. Chanprapaph K, Pratumchart N, Limtong P, Rutnin S, Sukasem C, Kungvalpivat P, et al. Dipeptidyl peptidase-4 inhibitor-related bullous pemphigoid: a comparative study of 100 patients with bullous pemphigoid and diabetes mellitus. J Dermatol. 2021;48:486–96. https://doi.org/10.1111/1346-8138.15778

    Article  PubMed  CAS  Google Scholar 

  5. He MJ, Wang YJ, Ran DL, Fu DS, He Q, Zhang HY, et al. Relationship between bullous pemphigoid and malignancy: a Mendelian randomization study. J Dermatol. 2024;51:403–8. https://doi.org/10.1111/1346-8138.17100

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kim BR, Lee KH, Paik K, Kim M, Bae JM, Choi CW, et al. Comorbid diseases in bullous pemphigoid: a population-based case-control study. J Dermatol. 2024;52:460–71. https://doi.org/10.1111/1346-8138.17577

    Article  PubMed  CAS  Google Scholar 

  7. Moiz A, Zolotarova T, Eisenberg MJ. Outpatient management of essential hypertension: a review based on the latest clinical guidelines. Ann Med. 2024;56:2338242 https://doi.org/10.1080/07853890.2024.2338242

    Article  PubMed  PubMed Central  Google Scholar 

  8. Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6:e1000058 https://doi.org/10.1371/journal.pmed.1000058

    Article  PubMed  PubMed Central  Google Scholar 

  9. Kalińska-Bienias A, Kowalczyk E, Jagielski P, Bienias P, Kowalewski C, Woźniak K. The association between neurological diseases, malignancies and cardiovascular comorbidities among patients with bullous pemphigoid: case-control study in a specialized polish center. Adv Clin Exp Med. 2019;28:637–42. https://doi.org/10.17219/acem/90922

    Article  PubMed  Google Scholar 

  10. Sim B, Fook-Chong S, Phoon YW, Koh HY, Thirumoorthy T, Pang SM, et al. Multimorbidity in bullous pemphigoid: a case-control analysis of bullous pemphigoid patients with age- and gender-matched controls. J Eur Acad Dermatol Venereol. 2017;31:1709–14. https://doi.org/10.1111/jdv.14312

    Article  PubMed  CAS  Google Scholar 

  11. Teixeira VB, Cabral R, Brites MM, Vieira R, Figueiredo A. Bullous pemphigoid and comorbidities: a case-control study in portuguese patients. An Bras Dermatol. 2014;89:274–8. https://doi.org/10.1590/abd1806-4841.20142516

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yang YW, Chen YH, Xirasagar S, Lin HC. Increased risk of stroke in patients with bullous pemphigoid: a population-based follow-up study. Stroke. 2011;42:319–23. https://doi.org/10.1161/strokeaha.110.596361

    Article  PubMed  Google Scholar 

  13. Pankakoski A, Sintonen H, Ranki A, Kluger N. Comorbidities of bullous pemphigoid in a finnish cohort. Eur J Dermatol. 2018;28:157–61. https://doi.org/10.1684/ejd.2018.3243

    Article  PubMed  CAS  Google Scholar 

  14. Ganji R, Mahboubi-Fooladi Z, Shahidi-Dadras M, Tehranchinia Z, Abdollahimajd F, Ghalamkarpour F, et al. Brain MRI findings in patients with bullous pemphigoid: a case-control study. Exp Dermatol. 2023;32:542–6. https://doi.org/10.1111/exd.14748

    Article  PubMed  Google Scholar 

  15. Kibsgaard L, Rasmussen M, Lamberg A, Deleuran M, Olesen AB, Vestergaard C. Increased frequency of multiple sclerosis among patients with bullous pemphigoid: a population-based cohort study on comorbidities anchored around the diagnosis of bullous pemphigoid. Br J Dermatol. 2017;176:1486–91. https://doi.org/10.1111/bjd.15405

    Article  PubMed  CAS  Google Scholar 

  16. Kwa MC, Silverberg JI. Association between inflammatory skin disease and cardiovascular and cerebrovascular co-morbidities in US adults: analysis of nationwide inpatient sample data. Am J Clin Dermatol. 2017;18:813–23. https://doi.org/10.1007/s40257-017-0293-x

    Article  PubMed  Google Scholar 

  17. AşIran Serdar Z, Aktaş Karabay E, Yaşar S, Kazaz N. Clinical features, associated systemic diseases, mortality rates, and treatment protocols in a group of Turkish patients with bullous pemphigoid. Turk Klin Dermatol Özel. 2018;28:44–50. https://doi.org/10.5336/dermato.2018-61536

    Article  Google Scholar 

  18. Kalinska-Bienias A, Piotrowski T, Kowalczyk E, Lesniewska A, Kaminska M, Jagielski P, et al. Actigraphy-measured nocturnal wrist movements and assessment of sleep quality in patients with bullous pemphigoid: a pilot case–control study. Clin Exp Dermatol. 2019;44:759–65. https://doi.org/10.1111/ced.13902

    Article  PubMed  CAS  Google Scholar 

  19. Kılıç Sayar S, Sun GP, Küçükoğlu R. Comorbidities of bullous pemphigoid: a single-center retrospective case–control study from Turkey. Dermatol Ther. 2021;34:e15031 https://doi.org/10.1111/dth.15031

    Article  PubMed  CAS  Google Scholar 

  20. Wu CY, Wu CY, Li CP, Chou YJ, Lin YH, Chang YT. Association between dipeptidyl peptidase-4 inhibitors and risk of bullous pemphigoid in patients with type 2 diabetes: a population-based cohort study. Diabetes Res Clin Pract. 2021;171:108546 https://doi.org/10.1016/j.diabres.2020.108546

    Article  PubMed  CAS  Google Scholar 

  21. Martin E, Mauer I, Malzahn U, Heuschmann PU, Goebeler M, Benoit S. Comorbid diseases among bullous pemphigoid patients in Germany: new insights from a case-control study. J Dtsch Dermatol Ges. 2022;20:798–805. https://doi.org/10.1111/ddg.14738

    Article  PubMed  Google Scholar 

  22. Shen WC, Chiang HY, Chen PS, Lin YT, Kuo CC, Wu PY. Risk of all-cause mortality, cardiovascular disease mortality, and cancer mortality in patients with bullous pemphigoid. JAMA Dermatol. 2022;158:167–75. https://doi.org/10.1001/jamadermatol.2021.5125

    Article  PubMed  Google Scholar 

  23. Titou H, Kerrouch H, Frikh R, Hjira N. The association between bullous pemphigoid and comorbidities: a case-control study in Moroccan patients. Acta Dermatovenerol Alp Pannonica Adriat. 2022;31:7–11.

    PubMed  Google Scholar 

  24. Zhang B, Chen X, Liu Y, Chen F, Yang N, Li L. Relationship between bullous pemphigoid and metabolic syndrome: a 12-year case-control study conducted in China. Ther Adv Chronic Dis. 2022;13:20406223221130707 https://doi.org/10.1177/20406223221130707

    Article  PubMed  PubMed Central  Google Scholar 

  25. Stirnadel-Farrant HA, Xu X, Kwiatek J, Jain P, Meyers J, Candrilli S, et al. Characteristics, treatment patterns, health care resource utilization and costs in patients with bullous pemphigoid: a retrospective analysis of US health insurance claims data. JAAD Int. 2023;13:117–25. https://doi.org/10.1016/j.jdin.2023.04.014

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sumitra S, Chandran R, George AE. Proportion of Co-morbidities in patients with and without bullous pemphigoid: a cross-sectional study. J Clin Diagn Res. 2023;17:WC5–WC8. https://doi.org/10.7860/jcdr/2023/64111.18091

    Article  CAS  Google Scholar 

  27. Wu PC, Wu CY, Lyu YS, Chang YT, Wu CY. Association between bullous pemphigoid and atopic dermatitis: a population-based case-control study in Taiwan. Arch Dermatol Res. 2023;315:419–27. https://doi.org/10.1007/s00403-022-02372-w

    Article  PubMed  Google Scholar 

  28. Bastuji-Garin S, Joly P, Lemordant P, Sparsa A, Bedane C, Delaporte E, et al. Risk factors for bullous pemphigoid in the elderly: a prospective case–control study. J Invest Dermatol. 2011;131:637–43. https://doi.org/10.1038/jid.2010.301

    Article  PubMed  CAS  Google Scholar 

  29. Schmidt E, Sticherling M, Sárdy M, Eming R, Goebeler M, Hertl M, et al. S2k guidelines for the treatment of pemphigus vulgaris/foliaceus and bullous pemphigoid: 2019 update. J Dtsch Dermatol Ges. 2020;18:516–26. https://doi.org/10.1111/ddg.14097

    Article  PubMed  Google Scholar 

  30. Fardet L, Kassar A, Cabane J, Flahault A. Corticosteroid-induced adverse events in adults: frequency, screening and prevention. Drug Saf. 2007;30:861–81. https://doi.org/10.2165/00002018-200730100-00005

    Article  PubMed  CAS  Google Scholar 

  31. Conn HO, Poynard T. Corticosteroids and peptic ulcer: meta-analysis of adverse events during steroid therapy. J Intern Med. 1994;236:619–32. https://doi.org/10.1111/j.1365-2796.1994.tb00855.x

    Article  PubMed  CAS  Google Scholar 

  32. Aremu OG, Asowata OJ, Danladi DK, Okekunle AP, Akpa OM. Sleep quality and hypertension in an indigenous African population: a cross-sectional investigation from the COMBAT-CVDs study. J Hum Hypertens. 2025;39:164–70. https://doi.org/10.1038/s41371-024-00971-w

    Article  PubMed  Google Scholar 

  33. Bock JM, Vungarala S, Covassin N, Somers VK. Sleep duration and hypertension: epidemiological evidence and underlying mechanisms. Am J Hypertens. 2022;35:3–11. https://doi.org/10.1093/ajh/hpab146

    Article  PubMed  CAS  Google Scholar 

  34. Bağcı IS, Horváth ON, Ruzicka T, Sárdy M. Bullous pemphigoid. Autoimmun Rev. 2017;16:445–55. https://doi.org/10.1016/j.autrev.2017.03.010

    Article  PubMed  Google Scholar 

  35. Försti A-K, Jokelainen J, Ansakorpi H, Seppänen A, Majamaa K, Timonen M, et al. Psychiatric and neurological disorders are associated with bullous pemphigoid – a nationwide finnish care register study. Sci Rep. 2016;6:37125 https://doi.org/10.1038/srep37125

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Yousaf M, Ayasse M, Ahmed A, Gwillim EC, Janmohamed SR, Yousaf A, et al. Association between atopic dermatitis and hypertension: a systematic review and meta‐analysis*. Br J Dermatol. 2021;186:227–35. https://doi.org/10.1111/bjd.20661

    Article  PubMed  CAS  Google Scholar 

  37. Kridin K, Goychberg R, Kridin M, Kafri N, Barhoum M, Cohen AD. The cardiovascular risk in bullous pemphigoid: insights from a population-based study. Australas J Dermatol. 2024;65:e187–e93. https://doi.org/10.1111/ajd.14355

    Article  PubMed  Google Scholar 

  38. Kringeland E, Gerdts E, Ulvik A, Tell GS, Igland J, Haugsgjerd TR, et al. Inflammation, sex, blood pressure changes and hypertension in midlife: the Hordaland health study. J Hum Hypertens. 2023;37:718–25. https://doi.org/10.1038/s41371-022-00772-z

    Article  PubMed  Google Scholar 

  39. Marzano AV, Tedeschi A, Fanoni D, Bonanni E, Venegoni L, Berti E, et al. Activation of blood coagulation in bullous pemphigoid: role of eosinophils, and local and systemic implications. Br J Dermatol. 2009;160:266–72. https://doi.org/10.1111/j.1365-2133.2008.08880.x

    Article  PubMed  CAS  Google Scholar 

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Funding

National Natural Science Foundation of China (82073438), Anhui key research and development programme projects (2022e07020041), The Postgraduate Innovation Research and Practice Program of Anhui Medical University (YJS20240029).

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Authors and Affiliations

  1. Department of Dermatology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China

    XiaoLi Yang, XiaoRan Tao, PanLing Wei, Chen Xu, JinPing Gao, FuSheng Zhou & ZaiXing Wang

  2. Institute of Dermatology, Anhui Medical University, Hefei, Anhui, China

    XiaoLi Yang, XiaoRan Tao, PanLing Wei, Chen Xu, JinPing Gao, FuSheng Zhou & ZaiXing Wang

  3. Key Laboratory of Dermatology (Anhui Medical University), Ministry of Education, Hefei, Anhui, China

    XiaoLi Yang, XiaoRan Tao, PanLing Wei, Chen Xu, JinPing Gao, FuSheng Zhou & ZaiXing Wang

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Contributions

XLY participated in the writing of paper, the literature search and the data analysis. XRT, PLW and CX searched the literature, collected the data, analyzed the data. ZXW, JPG and FSZ gave research guidance, revised the manuscript. All authors have read and approved the final manuscript.

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Correspondence to ZaiXing Wang.

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Ethical approval was waived by the Ethics Committee of Anhui Medical University since the study did not involve any patient-specific information. All methods were performed in accordance with the relevant guidelines and regulations. No experiments involving human participants were performed.

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Yang, X., Tao, X., Wei, P. et al. Association between bullous pemphigoid and hypertension: a systematic review and meta-analysis of observational studies. J Hum Hypertens 39, 666–674 (2025). https://doi.org/10.1038/s41371-025-01056-y

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