[10] Their distribution was strongly controlled by temperature, with the species only extending to the northern parts of Europe during warmer interglacial intervals.

[11] The oldest records of H. antiquus date to the Early Pleistocene, around 2.1-2 million years ago, which are found in Italy and Greece.

[13] H. antiquus first became widespread north of the Alps around 1.1 to 1 million years ago, as evidenced from specimens found dating to this time in France, Germany, the Netherlands and southern Britain.

[10][15] The Cretan dwarf hippopotamus (H. creutzburgi) is believed to have evolved from H. antiquus through the process of insular dwarfism on the island of Crete.

[17] Remains of the species with cut marks suggestive of butchery by archaic humans have been reported from several sites in Spain, dating to the late Early Pleistocene, including Barranco León (~1.4 Ma), Fuente Nueva 3 (~1.3 Ma), and Vallparadís (~1.0 Ma), At the Marathousa 2 site in Greece, thought to date to the Middle Pleistocene around 500-400,000 years ago, remains of a juvenile Hippopotamus antiquus individual with cut marks were found associated with a lithic artefact.