Cathy Wong is a nutritionist and wellness expert. Her work is regularly featured in media such as First For Women, Woman's World, and Natural Health.

Arno Kroner, DAOM, LAc, is a board-certified acupuncturist, as well as an herbalist and integrative medicine doctor. He operates a private practice in Santa Monica, California.

A member of the rose family, hawthorn (Crataegus monogyna) is a thorny, flowering tree or shrub native to temperate regions of Europe, North America, and northern Asia. Though the tiny sweet red berries ("haws") are used in jams, jellies, candies, and wines, all parts of the plant—the leaves, flowers, berries, stems, and even the bark—have long been used in herbal medicine as digestive, kidney, and anti-anxiety aids. It's also prominent as a tonic for treating cardiac diseases and for strengthening the aging heart, a use that dates back to the first century.

During the Middle Ages, hawthorn was employed for the treatment of dropsy, a condition that's now called congestive heart failure. The first study on hawthorn, published in 1896, reported on 43 patients suffering from various forms of heart disease who were treated with hawthorn with promising results.

In modern times, this ancient medicinal herb, which is widely available in many forms as a dietary supplement, is still popular for its effects on heart health, primarily:

The leaves, flowers, and berries of hawthorn contain an abundance of phytonutrients (antioxidants) called oligomeric proanthocyanidins and flavonoids, which are thought to be responsible for its pharmacologic effect.

Hawthorn is a thorny, flowering tree or shrub of the rose family. The leaves, flowers, berries, stems, and even the bark of the plant are often used in herbal medicine to help treat heart disease, digestive issues, and more.

According to a report by Memorial Sloan Kettering Cancer Center, scientists think hawthorn benefits the heart by causing a dilation of the smooth muscle that lines the coronary arteries, thereby increasing blood flow to the heart. Hawthorn is also thought to increase heart muscle contraction, heart rate, nerve transmission, and heart muscle irritability.

Many, but not all, studies suggest a benefit for hawthorn for this use. According to a 2008 review of 14 studies that included a total of 855 chronic heart failure patients, hawthorn may help manage symptoms and improve physiologic outcomes when used as a supporting treatment for chronic heart failure. The review's findings indicate that treatment with hawthorn may lead to improvement in exercise tolerance and in symptoms, such as fatigue and shortness of breath. The researchers concluded that "there is a significant benefit in symptom control and physiologic outcomes from hawthorn extract as an adjunctive treatment for chronic heart failure."

However, one long-term study completed in 2009 did not confirm these benefits. In this study, 120 patients with heart failure were randomized to receive 450 milligrams of hawthorn twice a day or a placebo for six months. Hawthorn provided no symptomatic or functional benefit when given with standard medical therapy.

Studies with hawthorn are conflicting for its effectiveness in reducing high blood pressure. In a pilot study published in 2002, 38 mildly hypertensive volunteers were assigned to a daily supplement of 600 milligrams of magnesium, 500 milligrams of hawthorn extract, a combination of magnesium and hawthorn, or a placebo. After 10 weeks, the 19 subjects who took hawthorn extract showed a greater reduction in resting diastolic blood pressure than other study members. What's more, hawthorn-taking participants were found to have lower levels of anxiety.

In a study published in 2006, scientists discovered that taking 1,200 milligrams a day of hawthorn extract helped lower blood pressure among individuals taking prescription drugs to treat their type 2 diabetes.

However, a more recent study, published in 2012, found that taking 1,000 milligrams, 1,500 milligrams, or 2,500 milligrams of hawthorn extract twice daily for three and a half days did not affect blood pressure in hypertensive individuals.

Hawthorn did show benefit for chest pain (angina) in patients with congestive heart failure. The evidence for atherosclerosis, the buildup of fatty deposits in your arteries, is very preliminary: A number of animal studies, including one published in 2018, suggests that hawthorn may help reduce levels of blood fats (including cholesterol) and aid in the prevention of atherosclerosis. More studies are needed to confirm these benefits.

Hawthorn is approved for congestive heart failure by Germany's Commission E, an expert panel that evaluates herbal remedies. However, given the extremely serious nature of heart disease, it's imperative not to attempt to self-treat a heart condition with hawthorn (or any other herbal remedy). Make sure to consult your healthcare provider if you're considering the use of hawthorn in the treatment of a heart problem.

Read about the many benefits of prickly ash.

Fresh hawthorn can be prepared as a tincture, a concentrated liquid herbal extract, and an infusion, which is basically a tea. In his book, "The New Healing Herbs," herbal expert Michael Castleman says to take one teaspoon of a homemade tincture every morning and evening for several weeks. To prepare an infusion, use two teaspoons of crushed leaves or fruit per cup of boiling water and steep for 20 minutes; drink up to two cups a day.

The most rigorously studied hawthorn extract, WS 1442, is standardized to 17 percent to 20 percent oligomeric procyanidins, and can be purchased in commercial preparations, including tablets, capsules, and tinctures. 

The most effective dosage isn't currently known. Recommended dosages range from 160 to 1,800 milligrams a day in two or three divided doses for over three to 24 weeks, but it's believed that greater therapeutic effectiveness results from higher dosages. A minimum effective dose for adjunctive therapy in mild congestive heart failure is 300 milligrams of standardized extract daily. Clinical trials conducted in patients with class II and III congestive heart failure found 900 milligrams of hawthorn extract daily to be safe, but not better than placebo.

Hawthorn is known to be slow-acting, so a trial of at least four to eight weeks should be completed to determine if you'll benefit from its use.

Hawthorn is generally considered safe when used at recommended doses short-term (up to 16 weeks). It caused no significant side effects in studies. The most common adverse effects are vertigo and dizziness, though less commonly it may trigger nausea and other intestinal symptoms, fatigue, headache, palpitations, sedation, nosebleeds and sweating. Overdosing can result in low blood pressure and cardiac arrhythmias.

Hawthorn may increase the effectiveness of some heart medications and interfere with others. Only take it under your healthcare provider's supervision if you've been prescribed blood pressure medication or Lanoxin (digoxin), and don't take it with other herbs or supplements that have cardiac effects.

Note that supplements haven't been tested for safety and due to the fact that dietary supplements are largely unregulated, the content of some products may differ from what is specified on the product label. Also keep in mind that the safety of supplements in pregnant women, nursing mothers, children, and those with medical conditions or who are taking medications have not been established. If you're considering the use of hawthorn, talk with your primary care provider first.

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Holubarsch CJF, Colucci WS, Eha J. Benefit-Risk Assessment of Crataegus Extract WS 1442: An Evidence-Based Review. Am J Cardiovasc Drugs. 2018;18(1):25-36. doi:10.1007/s40256-017-0249-9

Memorial Sloan Kettering Cancer Center. Hawthorn.

Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008;(1):CD005312. doi:10.1002/14651858.CD005312.pub2

Zick SM, Vautaw BM, Gillespie B, Aaronson KD. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail. 2009;11(10):990-9. doi:10.1093/eurjhf/hfp116

Walker AF, Marakis G, Morris AP, Robinson PA. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytother Res. 2002;16(1):48-54. doi:10.1002/ptr.947

Walker AF, Marakis G, Simpson E, et al. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen Pract. 2006;56(527):437-43.

Asher GN, Viera AJ, Weaver MA, Dominik R, Caughey M, Hinderliter AL. Effect of hawthorn standardized extract on flow mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial. BMC Complement Altern Med. 2012;12:26. doi:10.1186/1472-6882-12-26

Wang SZ, Wu M, Chen KJ, et al. Hawthorn Extract Alleviates Atherosclerosis through Regulating Inflammation and Apoptosis Related Factors: An Experimental Study. Chin J Integr Med. 2019;25(2):108-115. doi10.1007/s11655-018-3020-4

Castleman M. The New Healing Herbs, The Essential Guide to More Than 125 of Nature's Most Potent Herbal Remedies. Rodale; 2010.

Dahmer S, Scott E. Health effects of hawthorn. Am Fam Physician. 2010;81(4):465-8.

American Family Physicians. Health Effects of Hawthorn.

Asher GN, Viera AJ, Weaver MA, Dominik R, Caughey M, Hinderliter AL. Effect of hawthorn standardized extract on flow-mediated dilation in prehypertensive and mildly hypertensive adults: a randomized, controlled cross-over trial. BMC Complement Altern Med. 2012 Mar 29;12:26.

Castleman, Michael. "The New Healing Herbs."

Holubarsch Christian J. F., Wilson S. Colucci, Jaan Eha. Benefit-Risk Assessment of Crataegus Extract WS 1442: An Evidence-Based Review. Am J Cardiovasc Drug. 2018; 18(1): 25–36.

Memorial Sloan Kettering Cancer Center. Hawthorn.

Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008 23;(1):CD005312.

Tadiæ VM, Dobriæ S, Markoviæ GM, et al. Anti-inflammatory, gastroprotective, free-radical-scavenging, and antimicrobial activities of hawthorn berries ethanol extract. J Agric Food Chem. 2008 Sep 10;56(17):7700-9. 

Walker AF, Marakis G, Morris AP, Robinson PA. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytother Res. 2002 16(1):48-54.

Walker AF, Marakis G, Simpson E, Hope JL, Robinson PA, Hassanein M, Simpson HC. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen Pract. 2006 56(527):437-43.

Wang Song-zi, Wu Min, Chen Ke-ji, Liu Yue, Sun Jing, Sun Zhuo, Ma He, and Liu Long-tao. Hawthorn Extract Alleviates Atherosclerosis through Regulating Inflammation and Apoptosis-Related Factors: An Experimental Study. Chinese Journal of Integrative Medicine. December 2018.

Xu H, Xu HE, Ryan D. A study of the comparative effects of hawthorn fruit compound and simvastatin on lowering blood lipid levels. Am J Chin Med. 2009;37(5):903-8.

Zick SM, Vautawa BM, Gillespie B, Aaronson KD. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail. 2009 Oct;11(10):990-9.

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