Hawthorn Overview

The name "hawthorn" is derived from "hedgethorn," reflecting this spiny tree's use as a living fence in much of Europe. Besides protecting estates from trespassers, hawthorn has also been used medicinally since ancient times. Roman physicians used hawthorn as a heart drug in the first century AD, but most of the literature from that period focuses on its symbolic use for religious rites and political ceremonies.

During the Middle Ages, hawthorn was used for the treatment of dropsy, a condition we now call congestive heart failure. It was also used for treating other heart ailments as well as for sore throat.

At least nine reasonable quality, double-blind, placebo-controlled trials, involving a total of more than 750 participants, have found hawthorn effective for the treatment of mild to moderate congestive heart failure . ¹ In one of the best of these studies, 209 people with relatively advanced congestive heart failure (technically, New York Heart Association [NYHA] class III) were given either 1,800 mg or 900 mg of standardized hawthorn extract or matching placebo. ² The results after 16 weeks of therapy showed significant improvements in the hawthorn groups as compared to the placebo groups. Benefits in the high-dose hawthorn group included a reduction in subjective symptoms as well as an increase in exercise capacity. Subjective symptoms improved to a similar degree in the lower-dose hawthorn group, but there was no improvement in exercise capacity.

In an analysis that mathematically combined the results of 10 controlled trials involving 855 patients, hawthorn extract was found to be significantly better than placebo for improving exercise tolerance, decreasing shortness of breath and fatigue, and enhancing the physiologic function of an ailing heart in mild to moderate CHF . ³ In another study, however, researchers found that patients with mild-to-moderate CHF taking a special extract of hawthorn,900 mg daily, were more likely to experience an initial worsening of their condition compared to those taking a placebo. But, by the end of six months, there was no difference in the two groups. In light of numerous other studies supporting the safety and effectiveness of hawthorn in CHF, the results of this special extract study need to be repeated before drawing any firm conclusions. ⁴ A comparative study suggests that hawthorn extract (900 mg) is about as effective as a low dose of the conventional drug captopril. ⁵ However, while captopril and other standard drugs in the same family have been shown to help reduce hospitalizations and mortality associated with CHF, there is no similar evidence for hawthorn.

The usual dosage of hawthorn is 300 to 600 mg 3 times daily of an extract standardized to contain about 2% to 3% flavonoids or 18% to 20% procyanidins. Studies indicate that full effects may take up to 6 months to develop, although some improvement should be apparent much sooner.

1. Rietbrock N, Hamel M, Hempel B, Mitrovic V, Schmidt T, Wolf GK. [Actions of standardized extracts of Crataegus berries on exercise tolerance and quality of life in patients with congestive heart failure] Arzneimittelforschung. 51(10):793-8.
2. Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J. 143(5):910-5.
3. Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. (1):CD005312.
4. Zick SM, Gillespie B, Aaronson KD. The effect of Crataegus oxycantha special extract WS 1442 on clinical progression in patients with mild to moderate symptoms of heart failure. Eur J Heart Fail. 2008 May 17.
5. Tauchert M, Siegel G, Schulz V. Hawthorn extract as plant medication for the heart; a new evaluation of its therapeutic effectiveness [translated from German]. MMW Munch Med Wochenschr. 1994;136(suppl 1):S3-S5.