Europe's hotspot region for hypertension: the Balkans

Hypertension remains the leading modifiable risk factor for cardiovascular morbidity and premature mortality worldwide. While its prevalence has declined across much of Europe in recent decades, this trend has not been observed in the Balkan region, where rates remain persistently high. This narrative review aims to synthesise current evidence on the epidemiology of hypertension in the Balkans and to explore potential determinants underlying this sustained burden.

We conducted a narrative review of available literature, including population-based surveys, reports from the World Health Organization, and national epidemiological data from Balkan countries. Relevant studies were identified to evaluate prevalence patterns and associated determinants of hypertension across the region.

Data consistently indicate that hypertension prevalence in most Balkan countries approaches or exceeds 50% of the adult population. However, notable intra-regional variation exists, with Türkiye and Greece demonstrating prevalence levels closer to global averages. The excess burden of hypertension in the Balkans appears to be multifactorial, associated with persistently high dietary salt intake, socioeconomic disparities, structural limitations in healthcare systems, and region-specific environmental influences. These factors act synergistically rather than independently.

The Balkan region represents a distinct epidemiological hotspot for hypertension within Europe. The sustained high prevalence is likely driven by the convergence of multiple interacting determinants, in contrast to Western Europe where long-term investments in primary care-based prevention have led to declining rates. Effective management of hypertension in the Balkans will require integrated, context-specific strategies that extend beyond individual-level interventions.