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Lifetime dog guardianship and hypertension prevalence in Plovdiv

Angel Dzhambov, Donka Dimitrova, Vanina Mihaylova-Alakidi



Dog guardianship (DG) is a novel behavioral preventive intervention against arterial hypertension (AH) based on increased opportunities for physical activity, positive neuroendocrine response to stress and improved social capital. Current biomedical mindset in Bulgaria, however, is mostly focused on treatment rather than prevention through such unconventional approaches.


This study aimed to determine whether DG was associated with lower odds of prevalent AH.

Material and methods

A secondary analysis of a cross-sectional study among 513 residents of Plovdiv, Bulgaria was conducted. Data on self-reported doctor-diagnosis with AH, duration of lifetime dog guardianship (LDG) and confounding individual and environmental factors were available. A multivariate logistic regression model was set up to explore the odds of AH due to LDG; it was followed by sensitivity analyses to detect possible effect modification by individual differences.


We found 28.8% (95% CI: 2.6%, 47.9%) lower odds of AH per 8 years of LDG. This beneficial effect was more pronounced in males, people without family history of AH, who had never smoked, with lower socio-economic status, not obese and aged < 55 years.


Longer DG during one`s lifetime was associated with significantly lower odds of prevalent AH. Bulgarian public health exerts should explore it as an alternative preventive intervention for AH and contribute to fostering social acceptance of companion animals as means to enhance people`s health.


dog ownership; animal therapy; blood pressure; cardiovascular disease; non-communicable diseases; preventive medicine

Full Text


WHO. A global brief on hypertension Silent killer, global public health crisis. Geneva, 2013.

Stefanov TS, Temelkova-Kurktschiev TS. The metabolic syndrome in Bulgaria. Folia Med (Plovdiv) 2011;53(4):5-14.

National Statistical Institute. Healthcare 2014. Sofia; 2015.

Andreeva VA, Sakuma KL. Adapting smoking cessation programming to the Bulgarian context. Eval Health Prof 2008;31:290-6.

Levine GN, Allen K, Braun LT, Christian HE, Friedmann E, Taubert KA, Thomas SA, Wells DL, Lange RA; American Heart Association Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing. Pet ownership and cardiovascular risk: a scientific statement from the American Heart Association. Circulation 2013;127(23):2353-63.

Beetz A, Uvnäs-Moberg K, Julius H, Kotrschal K. Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Front Psychol. 2012;3:234.

Anderson WP, Reid CM, Jennings GL. Pet ownership and risk factors for cardiovascular disease. Med J Aust. 1992;157:298-301.

Allen K. Dog ownership and control of borderline hypertension: a controlled randomized trial. Presented at: 22nd Annual Scientific Sessions of the Society of Behavioral Medicine; March 24, 2001; Seattle, WA.

Allen K, Shykoff BE, Izzo JL Jr. Pet ownership, but not ACE inhibitor therapy, blunts home blood pressure responses to mental stress. Hypertension 2001;38:815-20.

Dzhambov A, Dimitrova D. Road traffic noise and annoyance: exposure-response relationship and burden of disease calculations in Bulgaria. Scr Sci Med 2015;47( 2):22-30.

Berglund B, Lindvall T, schwella DH (eds). Guidelines for Community Noise. World Health Organization, Geneva; 1999.

Jerrett M, Arain A, Kanaroglou P, et al. A review and evaluation of intraurban air pollution exposure models. J Expo Anal Environ Epidemiol 2005;15(2):185-204.

Municipality of Plovdiv. Program for reaching the normative levels of fine particulate matter under 2.5 microns (PM2,5) and polycyclic aromatic hydrocarbons (PAH) in the atmospheric air on the territory of Municipality of Plovdiv with action plan for the period 2013 - 2015; 2011 (in Bulgarian).

Lazarus H. Prediction of Verbal Communication is Noise - A review: Part 1. App Acoust 1986;19:439-64.

DeCarlo LT. On the meaning and use of kurtosis. Psychol Methods 1997;2:292-307.

Hoaglin DC, Iglewicz B. Fine tuning some resistant rules for outlier labeling. J Am Stat Assoc 1987;82:1147-9.

Schlomer GL, Bauman S, Card NA. Best practices for missing data management in counseling psychology. J Couns Psychol 2010;57:1-10.

Evans VP. Strategies for detecting outliers in regression analysis: An introductory primer, In: Thompson, B. (Ed.). Advances in social science methodology. Stamford, CT: JAI Press; 1999. vol. 5, pp. 213-233.

Schmider E; Ziegler, M; Danay, E; Beyer, L; Bühner, M. Is it really robust? Reinvestigating the robustness of ANOVA against violations of the normal distribution assumption. Meth Eur J Res Meth Behav Soc Sci 2010;6(4):147-51.

Tomarken, Andrew J.; Serlin, Ronald C. Comparison of ANOVA alternatives under variance heterogeneity and specific noncentrality structures. Psychological Bulletin, 1986;99(1):90-9.

Ruxton GD. The unequal variance t-test is an underused alternative to Student's t-test and the Mann--Whitney U test. Behavioral Ecology, 2006;17(4):688-90.

Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med 2008;3:17.

Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175-91.

Verma R, Balhara YPS, Gupta CS. Gender differences in stress response: Role of developmental and biological determinants. Ind Psychiatry J 2011;20:4-10.

Wright JD, Kritz-Silverstein D, Morton DJ, Wingard DL, Barrett-Connor E. Pet ownership and blood pressure in old age. Epidemiology. 2007;18:613-8.

Woodward M, editor. Cohort studies: Analytical considerations. In: Epidemiology: Study Design and Data Analysis. 3rd ed. Chapman and Hall/CRC. 2013. p. 169.

Veleva N, Draganova M. Is disease prevention a priority for Bulgarian public health policy? Folia Med (Plovdiv) 2015;57(Suppl 1):40.

Annerstedt M. Nature and Public Health: Aspects of Promotion, Prevention, and Intervention [PhD Thesis]. Swedish University of Agricultural Sciences, Alnarp; 2011.

Headey B. Pet ownership: good for health? Med J Aust. 2003;179:460-61.

Westgarth C, Christley RM, Christian HE. How might we increase physical activity through dog walking?: A comprehensive review of dog walking correlates. Int J Behav Nutr Phys Act. 2014;11:83.

Cutt H, Giles-Corti B, Knuiman M. "I'm Just a'-Walking the Dog" correlates of regular dog walking. Fam Community Health 2010;33(1):44-52.

Lee HS, Shepley M, Huang CS. Evaluation of off-leash dog parks in Texas and Florida: a study of use patterns, user satisfaction, and perception. Landscape Urban Plan 2009;92:314-24.

About The Authors

Angel Dzhambov
Faculty of Medicine, Medical University of Plovdiv

environmental hygiene/medicine, biostatistics, systematic reviews and meta-analyses

Donka Dimitrova
Department of Health Management, Health Economics and Primary Care, Medical University of Plovdiv, Plovdiv, Bulgaria

Vanina Mihaylova-Alakidi
Department of Healthcare, Medical University of Plovdiv, Plovdiv, Bulgaria and Department of Preventive Medicine, Medical University of Sofia, Sofia, Bulgaria

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