⚠ Evidence warning: Clinical trials or other evidence do not support the claims that hawthorn works as a heart tonic for heart failure and for angina. This page keeps it as a report of what people, websites or other media say.
Hawthorn — Benefits Deep Dive
Hawthorn (Crataegus monogyna, C. oxyacantha / laevigata, and C. pinnatifida) has been the European traditional "heart herb" for more than 400 years. Modern phytochemistry has identified its two principal active fractions — oligomeric proanthocyanidins (OPCs) from leaves and flowers and the flavonoids vitexin, hyperoside, and rutin — as the proposed molecular basis for its traditional cardiotonic effect. Germany's Commission E officially approved standardized Hawthorn extract for New York Heart Association (NYHA) Class II congestive heart failure. A 2008 Cochrane review pooled older small trials and found better maximal workload and symptoms, while the two later placebo-controlled trials, SPICE and HERB CHF, did not meet their main outcomes. The four deep-dive pages below explore Hawthorn's four distinct cardiovascular and emotional applications — heart failure, blood pressure, cardioprotection and angina, and the often-overlooked anxiolytic crossover effect for the patient who is "anxious-with-palpitations."
Deep-Dive Articles
Heart Failure
The HERB CHF 2009 placebo-controlled trial, the larger SPICE trial of a standardized leaf-and-flower extract in 2,681 New York Heart Association class II/III patients, and the German Commission E approved indication for New York Heart Association Class II congestive heart failure. The positive inotropic mechanism seen in the laboratory (not dependent on cyclic adenosine monophosphate, and similar to digoxin), its use alongside angiotensin-converting enzyme inhibitors (ACE inhibitors) and beta-blockers, and how Hawthorn is used as an add-on in mild-to-moderate systolic dysfunction, with the adverse events the long trials recorded.
Read the deep dive →Blood Pressure
The Walker 2002 double-blind pilot in 36 mildly hypertensive people (the resting diastolic result, p = 0.081, was not statistically significant), the Walker 2006 trial in 79 people with type 2 diabetes (diastolic group difference P = 0.035, systolic P = 0.329), the broader evidence base for Hawthorn's antihypertensive effect, and the dual ACE-inhibitor-like + vasodilator mechanism through flavonoid-mediated nitric oxide release and OPC-mediated angiotensin-converting enzyme suppression. How people with mild hypertension use it as a food-based, multi-mechanism approach.
Read the deep dive →Cardioprotection & Angina
Hawthorn's anti-arrhythmic effect (prolongs effective refractory period), its potent antioxidant cardiac protection against ischemia/reperfusion injury, the older European clinical use for stable angina and ischemic heart disease, and the long traditional history as a gentle "heart tonic" prescribed by herbalists from Dioscorides through Maud Grieve's 1931 Modern Herbal.
Read the deep dive →Anxiety & Mood
The mild GABAergic and serotonergic effects documented in animal models, the Hanus 2004 randomized trial in 264 people of a hawthorn + magnesium + California poppy combination for mild-to-moderate anxiety (Hamilton anxiety score down 10.6 versus 8.9 with placebo, p = 0.005; it was a three-part combination, so hawthorn's own share is unknown), and the unique "cardio-emotional crossover" niche — the patient who presents with palpitations, chest tightness, and free-floating anxiety where conventional medicine separates the cardiac and psychiatric workups. Historical use as a remedy for "broken heart" and grief.
Read the deep dive →Table of Contents
Why Hawthorn Produces Effects
Hawthorn is unusual among medicinal plants because its principal effects cluster in a single organ system — the cardiovascular — yet within that system it touches almost every distinct mechanism the heart and vasculature use to regulate themselves. The two active fractions are well characterized:
- Oligomeric proanthocyanidins (OPCs) — condensed tannins built from catechin and epicatechin monomers, concentrated in the leaves, flowers, and (to a lesser extent) berries. OPCs are described as the dominant cardioactive fraction in the standardized German leaf-and-flower extract used in the SPICE and HERB CHF trials, although the human heart-muscle study described below saw its effects in a flavone-enriched fraction.
- Flavonoids — principally vitexin and vitexin-2″-O-rhamnoside, hyperoside, rutin, and quercetin glycosides. These contribute the antioxidant, vasodilator, and mild anxiolytic effects.
Together these two fractions are reported to act on five distinct cardiovascular and neurologic mechanisms, which is the proposed reason for such a broad set of reported effects from a single botanical preparation. Most of this comes from laboratory and animal work, marked below; what is not known is how much of it happens at the blood levels reached by people taking hawthorn by mouth:
- Positive inotropic effect (increased force of cardiac contraction) — laboratory work on strips of human heart muscle. A standardized leaf-and-flower extract raised the force of contraction, including in muscle from failing hearts, without acting through cyclic adenosine monophosphate (cAMP). It also displaced ouabain from its binding site, and the authors conclude its mechanism is "similar to the cAMP-independent positive inotropic action of cardiac glycosides", the digoxin family. The effect was seen in a flavone-enriched fraction. A rat heart-cell study found no added response when hawthorn and digoxin were combined, which suggests both may bind the same site of the sodium-potassium pump (Na,K-ATPase). The inotropic effect is described as gentler than digoxin's, without digoxin's narrow therapeutic window, in mild-to-moderate heart failure; the long trials recorded the adverse events listed in the section on the large trials below.
- ACE-inhibitor-like activity — both the OPC fraction and several Hawthorn flavonoids inhibit angiotensin-converting enzyme in cell-free and animal models. This is proposed as one route to a reduction in blood pressure, through the same renin-angiotensin axis that lisinopril and enalapril target pharmacologically; human blood-pressure results do not establish that route. A 2025 pooled analysis of 6 trials with 428 people found systolic pressure about 6.65 mmHg lower with hawthorn after 2 to 6 months at 250 to 1200 mg/day, while the diastolic change (7.19 mmHg lower) was not statistically significant. Its authors call for larger trials.
- Endothelial vasodilation — laboratory and animal work reports that flavonoids in Hawthorn (particularly vitexin and hyperoside) trigger endothelial nitric oxide synthase (eNOS) activity, producing nitric-oxide-mediated vasodilation that complements the ACE-inhibitor-like effect. Vasodilation reduces afterload, the pressure the heart pumps against, which is why it is proposed for both the failing heart and the hypertensive patient.
- Antioxidant cardioprotection — the OPC fraction is among the most potent free-radical scavengers in the plant kingdom on a milligram-per-milligram basis. In animal models of ischemia/reperfusion injury, Hawthorn extract reduces infarct size and preserves contractile function, with the protective effect attributed to scavenging reactive oxygen species generated during reperfusion. This is the mechanism proposed for Hawthorn's traditional cardioprotective and anti-anginal effects.
- Mild nervine / anxiolytic action — flavonoids in Hawthorn show binding affinity for gamma-aminobutyric acid-A receptors in radioligand-binding studies, and animal models show anxiolytic activity in the elevated plus-maze paradigm at relevant doses. The serotonergic contribution appears smaller but is documented. This is the proposed molecular basis for the traditional use of Hawthorn for "anxious-with-palpitations" presentations. The human trial tested a three-part combination (264 people, 3 months), so hawthorn's own share is unknown.
The combined effect is what nineteenth-century herbalists called a "heart tonic" — a gentle, multi-mechanism agent that supports cardiac function across several axes simultaneously without the narrow therapeutic window of digoxin or the systemic effects of beta-blockers. Laboratory and animal work describes the actions above. In the two later heart-failure trials, a standardized extract had no significant effect on SPICE's main outcome, and HERB CHF's authors concluded that hawthorn gave no symptomatic or functional benefit.
Drug interaction note — digoxin and beta-blockers: because Hawthorn produces a mild positive inotropic effect of its own, the theoretical concern is additive contractility when combined with digoxin (also positive inotropic) or potential blunting of beta-blocker negative inotropic action. Hawthorn's inotropic effect is described as small enough that combination use is generally well tolerated. In a crossover study in 8 healthy volunteers (not heart-failure patients), 3 weeks of a standardized extract 450 mg twice daily with digoxin 0.25 mg did not significantly change digoxin blood levels (area under the curve 79 versus 73 mcg.h/L, p > 0.05). A later laboratory study found that hawthorn interfered with one digoxin immunoassay but not another, so a digoxin blood test can read wrongly on that assay. Citing that interference and the shared binding site, its authors state that "a patient receiving digoxin should avoid hawthorn." The Walker 2006 trial in people with diabetes on prescribed drugs found no herb-drug interaction. The SPICE trial enrolled patients on standard heart failure regimens (angiotensin-converting enzyme inhibitors, beta-blockers, diuretics), found adverse events comparable with placebo, and its authors called the extract safe to use with optimal medication.
Reported side effects: a 2024 review of 1,527 reports in the World Health Organization's global adverse-reaction database (1970 to 2023) most often names stomach and bowel, skin, general, heart and nervous-system complaints. In 277 of those reports a single-herb hawthorn product was the only suspect, and 12.6% of these were graded serious. Such reports show what was recorded and do not prove that hawthorn caused each event.
What the Large Heart-Failure Trials Found
- SPICE (a survival and prognosis trial, 2008) — 2,681 adults with New York Heart Association class II or III heart failure and a weak heart pump (ejection fraction 35% or lower), on top of standard treatment, took a standardized leaf-and-flower extract 900 mg/day or placebo for 24 months. A first cardiac event occurred in 27.9% versus 28.9% (hazard ratio 0.95, p = 0.476), and the authors state the extract "had no significant effect on the primary endpoint." Cardiac deaths did not differ significantly (p = 0.269). In a subgroup with ejection fraction 25% or higher, sudden cardiac death was 39.7% lower (p = 0.025), a result the authors say "may indicate" a possible effect. Adverse events were comparable, and the authors called the extract safe to use with optimal medication.
- HERB CHF (Hawthorn Extract Randomized Blinded Chronic Heart Failure trial, 2009) — 120 outpatients with New York Heart Association class II to III heart failure, on usual treatment, took hawthorn 450 mg twice daily or placebo for 6 months. Six-minute walk distance did not differ (P = 0.61), nor did quality of life, functional capacity, nerve-and-hormone markers, oxidative stress or inflammation. A modest difference in ejection fraction favoured hawthorn (P = 0.04). Significantly more adverse events were reported with hawthorn (P = 0.02), most of them not related to the heart. The authors conclude that "Hawthorn provides no symptomatic or functional benefit" on top of standard treatment.
- Further analysis of HERB CHF (published 2008) — a retrospective look at the same patients found that heart failure progressed in 46.6% with the extract and 43.3% with placebo (p = 0.86), with the risk of early progression 3.9 times higher with the extract (95% confidence interval 1.1 to 13.7, p = 0.035). The authors conclude that the extract "appears to increase the early risk" of progression.
- Older small trials (Cochrane review, 2008) — 14 trials met the review's criteria, and 10 of them, with 855 patients, could be pooled. Maximal workload rose by 5.35 watts over placebo, and shortness of breath and fatigue improved significantly. Adverse events were infrequent, mild and transient. These trials reported almost nothing on deaths or cardiac events, and they came before SPICE and HERB CHF.
Key Research Papers
- Holubarsch CJF et al. (2008). The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. European Journal of Heart Failure 10(12):1255-1263. — PubMed PMID: 19019730
- Zick SM, Vautaw BM, Gillespie B, Aaronson KD (2009). Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. European Journal of Heart Failure 11(10):990-999. — PubMed PMID: 19789403
- Zick SM, Gillespie B, Aaronson KD (2008). The effect of Crataegus oxycantha Special Extract WS 1442 on clinical progression in patients with mild to moderate symptoms of heart failure. European Journal of Heart Failure 10(6):587-593. — PubMed PMID: 18490196
- Pittler MH et al. (2008). Hawthorn extract for treating chronic heart failure (Cochrane review). Cochrane Database Syst Rev. — PubMed PMID: 18254076
- Walker AF et al. (2002). Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytotherapy Research 16(1):48-54. — PubMed PMID: 11807965
- Hanus M et al. (2004). Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders. Current Medical Research and Opinion 20(1):63-71. — PubMed PMID: 14741074
- Walker AF, Marakis G, Simpson E, Hope JL, Robinson PA, Hassanein M, Simpson HC (2006). Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. British Journal of General Practice 56(527):437-443. — PubMed PMID: 16762125
- Schwinger RH, Pietsch M, Frank K, Brixius K (2000). Crataegus special extract WS 1442 increases force of contraction in human myocardium cAMP-independently. Journal of Cardiovascular Pharmacology 35(5):700-707. — PubMed PMID: 10813370
- Tankanow R, Tamer HR, Streetman DS, Smith SG, Welton JL, Annesley T, Aaronson KD, Bleske BE (2003). Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). Journal of Clinical Pharmacology 43(6):637-642. — PubMed PMID: 12817526
- Dasgupta A, Kidd L, Poindexter BJ, Bick RJ (2010). Interference of hawthorn on serum digoxin measurements by immunoassays and pharmacodynamic interaction with digoxin. Archives of Pathology & Laboratory Medicine 134(8):1188-1192. — PubMed PMID: 20670141
- Szikora Z, Mátyus RO, Szabó BV, Csupor D, Tóth B (2025). Hawthorn (Crataegus spp.) Clinically Significantly Reduces Blood Pressure in Hypertension: A Meta-Analysis of Randomized Placebo-Controlled Clinical Trials. Pharmaceuticals (Basel) 18(7):1027. — PubMed PMID: 40732315
- Woerdenbag HJ, Ursidae M, Ekhart C, Schmidt M, Vitalone A, van Hunsel FPAM (2024). Analysis of Adverse Reactions Associated with the Use of Crataegus-Containing Herbal Products. Pharmaceuticals (Basel) 17(11):1490. — PubMed PMID: 39598401
External Authoritative Resources
- European Medicines Agency (EMA) — Crataegi folium cum flore herbal monograph — the EU's formal regulatory monograph on Hawthorn leaf and flower
- U.S. National Center for Complementary and Integrative Health (NCCIH) — Hawthorn — overview
- LiverTox (U.S. National Institutes of Health) — Hawthorn — consumer-facing safety and efficacy reference
- ESCOP — European Scientific Cooperative on Phytotherapy (Hawthorn leaf and flower monograph, fee-based access)
- PubMed — All research on Crataegus and the heart
Connections
- All Herbs
- Hawthorn (Main Page)
- Hawthorn for Heart Failure
- Hawthorn for Blood Pressure
- Hawthorn for Cardioprotection & Angina
- Hawthorn for Anxiety & Mood
- Heart Failure
- Hypertension
- Anxiety
- Chest Pain
- Edema
- Garlic
- Passionflower
- Lemon Balm
- Cardiovascular Health
- Blood Pressure (Celery Juice)
- Lipid Panel
- Quercetin
- History