Europe’s Hotspot Region for Hypertension: The Balkans

Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and premature mortality worldwide. Although the prevalence of hypertension has declined in much of Europe over recent decades, this trend has not been observed in the Balkan region, where rates remain persistently high. The Balkans therefore represent a distinct epidemiological hotspot within Europe, yet the underlying determinants of this sustained burden remain insufficiently explored.In this narrative review, we synthesize available evidence on the epidemiology of hypertension in the Balkan region. Data from population-based surveys, World Health Organization reports, and national statistics indicate that hypertension prevalence in most Balkan countries approaches or exceeds 50% of the adult population. Notably, Türkiye and Greece exhibit prevalence levels closer to the global average, highlighting substantial intra-regional variation.We discuss potential factors contributing to the excess burden of hypertension in the Balkans, including persistently high dietary salt intake, socioeconomic challenges, structural limitations of healthcare systems, and region-specific environmental factors. Rather than reflecting a single dominant risk factor, the available evidence suggests that the convergence of these interacting determinants distinguishes the Balkan region from Western Europe, where long-standing investments in primary care-based prevention and population-level hypertension control have contributed to declining prevalence.Addressing hypertension in the Balkans will require integrated, context-specific strategies that extend beyond individual risk modification.