Hawthorn

What Is Hawthorn?

Hawthorn is a thorny shrub or small tree of the rose family, widely planted as a hedge and used in Western herbal medicine as a remedy for the heart and circulation. Its leaves, white spring flowers and small red berries (“haws”) are all used.

Medicinal hawthorn comes mainly from two European species, Crataegus monogyna and C. laevigata, and their hybrids ^{29Reference 29Committee on Herbal Medicinal Products ( · 2016ReviewAssessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory reviewView study →}. Both are native to Europe, and C. monogyna also to western Asia and North Africa. It was brought to North America for hedging and now grows wild there ^{30,31Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →Reference 31PhippsPhipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118View study →}.

The leaves and flowers are rich in oligomeric procyanidins and flavonoids ^{23,25Reference 23Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 25Bone et al. · 2013Principles and Practice of Phytotherapy}. Standardised leaf-and-flower extracts have been tested for heart failure and high blood pressure. The heart-failure results have been mixed, and a meta-analysis found a modest fall in blood pressure ^{1,4,6Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →Reference 4Zick et al. · 2009RCTHawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trialView study →Reference 6Szikora et al. · 2025Meta-analysisHawthorn (Crataegus spp.) clinically significantly reduces blood pressure in hypertension: a meta-analysis of randomized placebo-controlled clinical trialsView study →}.

In Chinese medicine, the fruit of a different species, C. pinnatifida, is used as shan zha, mainly as a digestive ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

How Is Hawthorn Used?

• Leaf and flower tea — 1–2 g of dried leaf and flower infused in boiling water, up to four times a day ^{28Reference 28Committee on Herbal Medicinal Products ( · 2016ReviewEuropean Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monographView study →}.
• Standardised leaf-and-flower extracts — such as WS 1442 and LI 132, the preparations used in most clinical trials ^{9Reference 9Daniele et al. · 2006Systematic reviewAdverse-event profile of Crataegus spp.: a systematic reviewView study →}.
• Tinctures and fluid extracts — of the leaf and flower ^{28Reference 28Committee on Herbal Medicinal Products ( · 2016ReviewEuropean Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monographView study →}, or of the berry ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.
• Berries — the traditional Western part, taken as a decoction or tincture ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.
• Chinese shan zha — the fruit of C. pinnatifida, decocted or roasted ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

Traditional Uses

Western Herbal Medicine

In older Western texts hawthorn is given for heart and circulatory complaints: tachycardia, high blood pressure, angina and a weak heart muscle. The berries were used as an astringent gargle for sore throat and as a diuretic ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

The British Herbal Pharmacopoeia classes Crataegus as cardiotonic, coronary vasodilator and hypotensive. It lists it for cardiac failure, myocardial weakness, high blood pressure, arteriosclerosis, Buerger’s disease and paroxysmal tachycardia ^{27Reference 27British Herbal Medicine Association · 1983British Herbal Pharmacopoeia}.

It is often combined with other herbs. For arteriosclerosis it is paired with lime flower, garlic or cramp bark, and for high blood pressure with lime flower and skullcap ^{23Reference 23Hoffmann · 2003Medical herbalism: The science and practice of herbal medicine}. The British Herbal Pharmacopoeia names night-blooming cereus, lime flower, mistletoe and skullcap as partners ^{27Reference 27British Herbal Medicine Association · 1983British Herbal Pharmacopoeia}.

Traditional Western practice used the berry. Modern work found more flavonoids and procyanidins in the leaf and flower, and standardised cardiac extracts are now made from them ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

Outside medicine, the wood was widely worked and the berries were used to flavour liquor ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

Traditional Chinese Medicine: Shan Zha (Crataegus pinnatifida)

Chinese medicine uses the fruit of Crataegus pinnatifida, known as shan zha, rather than the European species ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

Shan zha is classified as sour and sweet in taste and slightly warm in nature, entering the Spleen, Stomach and Liver channels. Its main action is to resolve food stagnation, especially from meat and greasy food. It is given for a heavy, undigested fullness after a rich meal, usually as a decoction or as the roasted fruit.

Its second action is to invigorate the blood and dispel stasis. The fruit is used for postpartum abdominal pain and for chest and abdominal pain from blood stasis ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

Indications

• Mild high blood pressure [leaf and flower extract]
• Mild chronic heart failure [leaf and flower extract] ⚠Caution: Early trials found better exercise tolerance and fewer symptoms when hawthorn was added to older heart-failure treatment. Added to current treatment, one trial found no benefit and more adverse events, and a large trial missed its main endpoint ^1,3,4.
• Palpitations and nervous heart complaints, once serious heart disease has been ruled out [leaf and flower; EU traditional use]
• Mild stress and poor sleep [leaf and flower; EU traditional use]
• Angina and poor coronary circulation [leaf, flower and berry; Western herbal use]
• Irregular heartbeat and paroxysmal tachycardia [leaf, flower and berry; Western herbal use]
• Atherosclerosis and high cholesterol [leaf and flower; Western herbal use] ⚠Caution: In a trial of 49 people with diabetes and coronary disease already taking statins, LDL cholesterol fell in the hawthorn group but did not differ significantly from placebo ²⁰.
• Anxiety [leaf and flower, in combination] ⚠Caution: The positive trial used hawthorn together with California poppy and magnesium, so hawthorn’s own effect is not known ²¹.
• Food stagnation after rich meals [fruit of C. pinnatifida; TCM]

Botany

Hawthorn is a thorny, deciduous shrub or small tree in the rose family (Rosaceae) ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}. The genus name Crataegus comes from the Greek for strength and a sharp point, after the thorns ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}.

Crataegus monogyna, common hawthorn, grows 4–10 m tall. Its leaves are 1.2–5.5 cm long and deeply cut into one to three pointed lobes on each side ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}. The white flowers are 8–16 mm across and grow in loose clusters of 5–15. Each has a single style and ripens into a dark red haw, 6–11 mm across, with a single stone ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}.

Crataegus laevigata, Midland or woodland hawthorn, grows to about 8 m. Its leaves are more shallowly lobed, with rounded lobes ^{31Reference 31PhippsPhipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118View study →}. Its flowers are 12–22 mm across, with two or three styles, and its bright red haws hold two or three stones ^{31Reference 31PhippsPhipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118View study →}. It tolerates more shade than most hawthorns ^{31Reference 31PhippsPhipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118View study →}.

The name Crataegus oxyacantha, used in older pharmacopoeias and many studies, is treated as a synonym of C. laevigata ^{29Reference 29Committee on Herbal Medicinal Products ( · 2016ReviewAssessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory reviewView study →}. The European Pharmacopoeia accepts the leaves and flowers of C. monogyna, C. laevigata or their hybrids, and more rarely of other European species ^{29Reference 29Committee on Herbal Medicinal Products ( · 2016ReviewAssessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory reviewView study →}.

Distribution

Crataegus monogyna is native to Europe, south-west Asia and North Africa. It grows in brush, woodland edges and old pastures ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}. Crataegus laevigata is widespread in central Europe and scarcer beyond it ^{31Reference 31PhippsPhipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118View study →}.

Common hawthorn was brought to North America early on for farm hedges. It now grows wild in southern Canada and many US states, and is locally common in the Pacific Northwest and from the Great Lakes to the Atlantic ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}. It has also been introduced to South America, southern Africa, New Zealand and Australia ^{30Reference 30PhippsPhipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576View study →}. In North America C. laevigata is known only from Washington’s San Juan Islands ^{31Reference 31PhippsPhipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118View study →}.

Growing Conditions

Cultivation snapshot for Hawthorn

LifeperennialZoneUSDA 4–7

• Thrives in full sun to partial shade; flowers and fruits best with more sun.
• Tolerant of a wide range of soils — heavy clay, poor, and chalky ground — as long as drainage is reasonable.
• Very cold-hardy and low-maintenance once established; suited to roughly temperate (USDA zones 4–7) climates.
• Responds well to hard pruning and is traditionally used for hedging; the thorns make siting near paths a consideration.

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Harvesting, Collection & Preparation

Traditional Western practice favoured the berries. Modern standardised extracts are made from the flowering tops, the leaves with flowers, which carry more flavonoids and procyanidins ^{25,29Reference 25Bone et al. · 2013Principles and Practice of PhytotherapyReference 29Committee on Herbal Medicinal Products ( · 2016ReviewAssessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory reviewView study →}.

Pharmacology & Research

Hawthorn has a larger body of human research than most herbs. It includes a Cochrane review of 14 heart-failure trials, two trials on top of modern heart-failure treatment (SPICE and HERB CHF), and a 2025 meta-analysis of blood-pressure trials ^{1,3,4,6Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →Reference 3Holubarsch et al. · 2008RCTThe efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial — randomised controlled trialView study →Reference 4Zick et al. · 2009RCTHawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trialView study →Reference 6Szikora et al. · 2025Meta-analysisHawthorn (Crataegus spp.) clinically significantly reduces blood pressure in hypertension: a meta-analysis of randomized placebo-controlled clinical trialsView study →}.

In heart failure, earlier trials that added hawthorn to older treatment found better exercise capacity and fewer symptoms ^{1Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →}. The two later trials on modern treatment found no benefit on their main outcomes ^{3,4Reference 3Holubarsch et al. · 2008RCTThe efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial — randomised controlled trialView study →Reference 4Zick et al. · 2009RCTHawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trialView study →}. For blood pressure, the meta-analysis found a fall in systolic pressure of about 6.7 mmHg ^{6Reference 6Szikora et al. · 2025Meta-analysisHawthorn (Crataegus spp.) clinically significantly reduces blood pressure in hypertension: a meta-analysis of randomized placebo-controlled clinical trialsView study →}.

The laboratory work maps several mechanisms: relaxation of blood vessels through nitric oxide, a positive effect on heart-muscle contraction, and protection of the heart in ischaemia models ^{11,16,18Reference 11Brixius et al. · 2006In vitroCrataegus special extract WS 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177 — in vitroView study →Reference 16Pöpping et al. · 1995AnimalEffect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes — animalView study →Reference 18Veveris et al. · 2004AnimalCrataegus special extract WS 1442 improves cardiac function and reduces infarct size in a rat model of prolonged coronary ischemia and reperfusion — animal modelView study →}. Nearly all of it used standardised leaf-and-flower extracts.

1. Chronic Heart Failure

A Cochrane review found 14 double-blind, placebo-controlled trials of hawthorn leaf-and-flower extract in chronic heart failure. In most, hawthorn was added to conventional treatment ^{1Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →}.

Ten trials with 855 patients (NYHA classes I–III) could be pooled. Hawthorn improved maximal workload by 5.35 W, raised exercise tolerance, lowered the pressure–heart-rate product, and eased breathlessness and fatigue compared with placebo ^{1,2Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →Reference 2Pittler et al. · 2003Meta-analysisHawthorn extract for treating chronic heart failure: meta-analysis of randomized trialsView study →}. Adverse events were infrequent, mild and short-lived ^{1Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →}.

The SPICE trial gave 2,681 patients with NYHA class II–III heart failure and reduced ejection fraction 900 mg a day of WS 1442 or placebo for 24 months, on top of their usual treatment. The time to a first cardiac event did not differ, and adverse events were similar in both groups. In patients with an ejection fraction of 25% or more, sudden cardiac death was 39.7% lower with hawthorn, a secondary finding ^{3Reference 3Holubarsch et al. · 2008RCTThe efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial — randomised controlled trialView study →}.

The HERB CHF trial gave 120 patients on standard treatment 450 mg of WS 1442 twice a day or placebo for six months. There was no difference in six-minute walk distance, quality of life, exercise capacity, or markers of oxidative stress and inflammation. Ejection fraction improved slightly with hawthorn. More adverse events were reported in the hawthorn group, most of them not cardiac ^{4Reference 4Zick et al. · 2009RCTHawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trialView study →}.

A later analysis of the HERB CHF data found no overall difference in heart-failure progression over six months, but a higher risk of early progression in the hawthorn group ^{5Reference 5Zick et al. · 2008RCTThe effect of Crataegus oxycantha special extract WS 1442 on clinical progression in patients with mild to moderate heart failure — retrospective analysis of the HERB CHF randomised controlled trialView study →}.

Gap: the symptomatic benefit was demonstrated mainly as add-on to pre-modern therapy; on today’s guideline-directed treatment the functional benefit is neutral-to-negative and there is no mortality benefit. The EU herbal committee concluded that the heart-failure trials do not prove a benefit, and recognised only traditional uses ^{29Reference 29Committee on Herbal Medicinal Products ( · 2016ReviewAssessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory reviewView study →}.

2. Antihypertensive

A 2025 meta-analysis of six randomised, placebo-controlled trials with 428 participants found that hawthorn lowered systolic blood pressure by an average of 6.65 mmHg. Diastolic pressure fell by 7.19 mmHg, a result that was not statistically significant ^{6Reference 6Szikora et al. · 2025Meta-analysisHawthorn (Crataegus spp.) clinically significantly reduces blood pressure in hypertension: a meta-analysis of randomized placebo-controlled clinical trialsView study →}. Treatment lasted from 10 weeks to 6 months, at doses of 250–1,200 mg a day ^{6Reference 6Szikora et al. · 2025Meta-analysisHawthorn (Crataegus spp.) clinically significantly reduces blood pressure in hypertension: a meta-analysis of randomized placebo-controlled clinical trialsView study →}.

The largest single trial randomised 79 people with type 2 diabetes, most already taking blood-pressure or diabetes drugs, to 1,200 mg a day of hawthorn extract or placebo for 16 weeks. Diastolic pressure fell more with hawthorn; systolic pressure did not differ between the groups. No herb–drug interaction was found ^{7Reference 7Walker et al. · 2006RCTHypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trialView study →}.

An earlier pilot in 36 people with mild high blood pressure gave 500 mg a day for 10 weeks. It showed a trend toward lower resting diastolic pressure that did not reach significance ^{8Reference 8Walker et al. · 2002RCTPromising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertensionView study →}.

The trials are small and vary widely in dose. No large dedicated hypertension trial exists.

3. Antioxidant & Vascular Protection

The standardised extract WS 1442 relaxed isolated rat aorta and human mammary artery by activating endothelial nitric-oxide synthase (eNOS) at serine 1177. The effect came from a fraction rich in large procyanidins and almost free of flavonoids ^{11Reference 11Brixius et al. · 2006In vitroCrataegus special extract WS 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177 — in vitroView study →}.

A follow-up in pig coronary arteries showed this activation runs through redox-sensitive Src and Akt signalling, not oestrogen receptors ^{12Reference 12Anselm et al. · 2009In vitroCrataegus special extract WS 1442 causes endothelium-dependent relaxation via a redox-sensitive Src- and Akt-dependent activation of endothelial NO synthase — in vitroView study →}.

In ageing rats, a diet containing WS 1442 prevented age-related loss of endothelial function by reducing oxidative stress and COX expression in the vessel wall ^{13Reference 13Idris-Khodja et al. · 2012AnimalCrataegus special extract WS 1442 prevents aging-related endothelial dysfunction — animal modelView study →}.

Gap: HERB CHF measured markers of oxidative stress and inflammation in people and found no difference from placebo ^{4Reference 4Zick et al. · 2009RCTHawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trialView study →}.

4. Positive Inotropy

Flavonoids inhibit the enzyme cyclic-AMP phosphodiesterase in rat heart tissue ^{15Reference 15Petkov et al. · 1981AnimalInhibitory effect of some flavonoids and flavonoid mixtures on cyclic AMP phosphodiesterase activity of rat heart — animalView study →}.

In isolated rat heart-muscle cells, the leaf-and-flower extract LI 132 increased the strength of contraction with a moderate rise in energy use. That rise was smaller than with isoprenaline, ouabain or extra calcium ^{16Reference 16Pöpping et al. · 1995AnimalEffect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes — animalView study →}. The extract also lengthened the cells’ refractory period ^{16Reference 16Pöpping et al. · 1995AnimalEffect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes — animalView study →}.

In isolated guinea-pig hearts, the main hawthorn flavonoids, luteolin-7-glucoside, hyperoside and rutin, increased coronary flow and the speed of relaxation, with slight positive effects on contraction. Vitexin-2″-O-rhamnoside and related C-glycosides had similar but weaker effects ^{17Reference 17Schüssler et al. · 1995Myocardial effects of flavonoids from Crataegus species — animal (isolated guinea-pig heart)View study →}.

Gap: entirely animal and in-vitro; there is no isolated human study of hawthorn’s inotropic effect, and it is inferred within the broader heart-failure trials rather than measured directly.

5. Coronary Vasodilation & Microcirculation

Procyanidins separated from hawthorn extract relaxed isolated rat aorta through nitric oxide, while the flavonoids hyperoside, rutin and vitexin did not ^{14Reference 14Kim et al. · 2000AnimalProcyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aorta — animalView study →}.

In isolated guinea-pig hearts, luteolin-7-glucoside raised coronary flow by 186%, and hyperoside and rutin by 66% each, at the highest concentration tested ^{17Reference 17Schüssler et al. · 1995Myocardial effects of flavonoids from Crataegus species — animal (isolated guinea-pig heart)View study →}.

No human imaging or coronary-flow study has tested hawthorn.

6. Antiarrhythmic

Rats given the extract LI 132 by mouth for three months before an ischaemia test had fewer dangerous heart rhythms after blood flow returned. In the longer ischaemia group, ventricular fibrillation and flutter fell from 89% to 51% ^{19Reference 19Al Makdessi et al. · 1999AnimalProtective effect of Crataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart — animalView study →}.

In isolated heart-muscle cells the same extract lengthened the refractory period, which may point to an antiarrhythmic effect ^{16Reference 16Pöpping et al. · 1995AnimalEffect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes — animalView study →}. In SPICE, sudden cardiac death was lower with WS 1442 in patients with an ejection fraction of 25% or more, a secondary finding ^{3Reference 3Holubarsch et al. · 2008RCTThe efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial — randomised controlled trialView study →}.

Gap: no dedicated human antiarrhythmic trial exists; the mechanism is rat-model and the human signal is a post-hoc subgroup.

7. Cardioprotection

Rats given WS 1442 by mouth for seven days before a four-hour coronary blockage had better heart function and smaller infarcts. At 100 mg/kg, ventricular fibrillation fell from 67% to 27% and deaths from 47% to 9% ^{18Reference 18Veveris et al. · 2004AnimalCrataegus special extract WS 1442 improves cardiac function and reduces infarct size in a rat model of prolonged coronary ischemia and reperfusion — animal modelView study →}.

A related rat model showed protection against dangerous rhythms after blood flow returned ^{19Reference 19Al Makdessi et al. · 1999AnimalProtective effect of Crataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart — animalView study →}.

Rodent work only, with no human heart-attack outcome data.

8. Hypolipidemic

A double-blind trial gave 49 people with diabetes and chronic coronary disease, all on statins, 400 mg of micronised Crataegus laevigata leaf and flower three times a day or placebo for six months ^{20Reference 20Dalli et al. · 2011RCTCrataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trialView study →}. In the hawthorn group LDL cholesterol fell from 105 to 93 mg/dL and non-HDL cholesterol also fell, but the differences from placebo were not significant. Neutrophil elastase, an inflammation marker, fell significantly compared with placebo ^{20Reference 20Dalli et al. · 2011RCTCrataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trialView study →}.

A 2024 trial in overweight adults tested a mixture of Crataegus pinnatifida leaf and Citrus unshiu peel. It reduced body fat and weight, and at the higher dose lowered triglycerides in a per-protocol analysis ^{22Reference 22Song et al. · 2024RCTEfficacy of a Crataegus extract mixture on body fat and lipid profiles in overweight adults: a 12-week randomized, double-blind, placebo-controlled trialView study →}.

Gap: the monopreparation effect is a non-significant within-group trend; the clearer result comes from a combination product of a different hawthorn species and cannot be attributed to European hawthorn.

9. Anxiolytic

A double-blind trial in 264 people with mild-to-moderate generalised anxiety compared a fixed combination of Crataegus oxyacantha, California poppy (Eschscholzia californica) and magnesium with placebo for three months. Anxiety scores fell more with the combination ^{21Reference 21Hanus et al. · 2004RCTDouble-blind, randomised, placebo-controlled study of a fixed combination of Crataegus oxyacantha and Eschscholtzia californica with magnesium in mild-to-moderate anxiety disordersView study →}.

In the hypertension pilot, people taking hawthorn showed a trend toward less anxiety that did not reach significance ^{8Reference 8Walker et al. · 2002RCTPromising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertensionView study →}.

Gap: every positive result is a combination product; no trial has tested hawthorn alone for anxiety, so the effect cannot be attributed to the herb.

Mechanisms

Hawthorn’s procyanidins relax blood vessels by activating endothelial nitric-oxide synthase, which releases nitric oxide in the vessel wall ^{11,14Reference 11Brixius et al. · 2006In vitroCrataegus special extract WS 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177 — in vitroView study →Reference 14Kim et al. · 2000AnimalProcyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aorta — animalView study →}. This has been studied as the basis of its blood-pressure effect.

Its flavonoids have been studied for their effects on the heart muscle. They inhibit cyclic-AMP phosphodiesterase, and the whole extract strengthens contraction in isolated heart cells with a moderate rise in energy use ^{15,16,17Reference 15Petkov et al. · 1981AnimalInhibitory effect of some flavonoids and flavonoid mixtures on cyclic AMP phosphodiesterase activity of rat heart — animalView study →Reference 16Pöpping et al. · 1995AnimalEffect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes — animalView study →Reference 17Schüssler et al. · 1995Myocardial effects of flavonoids from Crataegus species — animal (isolated guinea-pig heart)View study →}.

Clinical Trials

The main single-herb trials, SPICE with WS 1442 and HERB CHF, are complete. Most recent entries on ClinicalTrials.gov test combination products rather than hawthorn alone, and no large trial is recruiting.

Last checked: July 2026.

Phytochemistry

Hawthorn leaves and flowers contain three main groups of compounds. The oligomeric procyanidins make up 1–2.4%, the flavonoids up to 1.78%, and the triterpene acids up to 0.6% ^{23,24,25Reference 23Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 24Blumenthal et al. · 2003The ABC clinical guide to herbsReference 25Bone et al. · 2013Principles and Practice of Phytotherapy}. The European Pharmacopoeia requires at least 1.5% total flavonoids, measured as hyperoside ^{29Reference 29Committee on Herbal Medicinal Products ( · 2016ReviewAssessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory reviewView study →}.

The flavonoids include vitexin, vitexin-2″-O-rhamnoside, hyperoside, rutin, quercetin and luteolin-7-glucoside ^{17,25Reference 17Schüssler et al. · 1995Myocardial effects of flavonoids from Crataegus species — animal (isolated guinea-pig heart)View study →Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}. The triterpene acids include ursolic, oleanolic and crataegolic (maslinic) acid ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}. The leaves also contain phenolic acids such as caffeic and chlorogenic acid ^{23,24,25Reference 23Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 24Blumenthal et al. · 2003The ABC clinical guide to herbsReference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

The smallest procyanidins are the dimers procyanidin B1 and procyanidin B2. Each is made of two flavan-3-ol units joined by a carbon–carbon bond, and they differ in whether the lower unit is catechin (B1) or epicatechin (B2).

The berries contain flavonoids, amines, catechols, carboxylic acid and triterpene acids ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}. The leaves and flowers carry more flavonoids and procyanidins than the berries ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}.

In laboratory studies, isolated constituents have often shown less activity than the whole extract ^{23,26Reference 23Hoffmann · 2003Medical herbalism: The science and practice of herbal medicineReference 26Occhiuto et al. · 1986Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2}. In isolated rat aorta, for example, the procyanidins relaxed the vessel while the flavonoids hyperoside, rutin and vitexin did not ^{14Reference 14Kim et al. · 2000AnimalProcyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aorta — animalView study →}.

Constituent Summary

Figures are percent of dried leaf and flower, the part used in standardised extracts.

Dosage

The EU herbal monograph gives traditional doses of the leaf and flower for adults ^{28Reference 28Committee on Herbal Medicinal Products ( · 2016ReviewEuropean Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monographView study →}:

• Tea — 1–2 g of dried leaf and flower in 150 mL of boiling water, up to four times a day, to a maximum of 6 g a day.
• Dry extracts — 240–900 mg a day for the alcohol-based dry extracts, taken in divided doses.
• Tincture (1:3.5–4.5) — about 1.7 g three times a day.

In research, hawthorn is almost always given as a standardised leaf-and-flower extract. WS 1442 is standardised to 18.75% oligomeric procyanidins and LI 132 to 2.25% flavonoids ^{9Reference 9Daniele et al. · 2006Systematic reviewAdverse-event profile of Crataegus spp.: a systematic reviewView study →}.

Traditional Dosage

Safety & Pregnancy

Hawthorn is well tolerated, and its side effects are mostly mild and short-lived. The main caution is that it is not a substitute for modern heart-failure treatment.

Full Safety & Interactions Detail

General tolerance. A systematic review of 24 clinical studies, with data on 5,577 patients, found that adverse events were mostly mild to moderate. The most common were dizziness, digestive complaints, headache, migraine and palpitations. Eight severe adverse events were reported, all with the LI 132 extract ^{9Reference 9Daniele et al. · 2006Systematic reviewAdverse-event profile of Crataegus spp.: a systematic reviewView study →}.

Heart failure. Earlier trials that added hawthorn to older treatment showed symptomatic benefit ^{1Reference 1Pittler et al. · 2008Meta-analysisHawthorn extract for treating chronic heart failure — systematic review and meta-analysisView study →}. In the HERB CHF trial, on modern treatment, it gave no functional benefit and more adverse events were reported, most of them not cardiac ^{4Reference 4Zick et al. · 2009RCTHawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trialView study →}. A later analysis of the same trial found a higher risk of early heart-failure progression ^{5Reference 5Zick et al. · 2008RCTThe effect of Crataegus oxycantha special extract WS 1442 on clinical progression in patients with mild to moderate heart failure — retrospective analysis of the HERB CHF randomised controlled trialView study →}. In the much larger SPICE trial, adverse events were similar with hawthorn and placebo ^{3Reference 3Holubarsch et al. · 2008RCTThe efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial — randomised controlled trialView study →}. Hawthorn should not be self-prescribed in place of heart-failure treatment.

When to see a doctor. The EU monograph advises seeing a doctor at once if the ankles or legs swell, if pain in the heart region spreads to the arms, upper abdomen or neck, or if breathing becomes difficult. Symptoms that last more than two weeks also need medical advice ^{28Reference 28Committee on Herbal Medicinal Products ( · 2016ReviewEuropean Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monographView study →}.

Digoxin. In a crossover study in 8 healthy volunteers, WS 1442 at 450 mg twice a day for three weeks did not change the pharmacokinetics of digoxin ^{10Reference 10Tankanow et al. · 2003RCTInteraction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha) — randomised crossover trial in healthy volunteers, n=8View study →}. Herbal texts report that hawthorn can add to the effects of digitalis glycosides and beta-blockers ^{25Reference 25Bone et al. · 2013Principles and Practice of Phytotherapy}, so monitoring is still sensible.

Other heart drugs. Added effects with cardiac glycosides, beta-blockers, antihypertensives and other cardiovascular drugs are plausible but have not been measured. No CYP450 interaction study exists, and the EU monograph reports no interactions ^{28Reference 28Committee on Herbal Medicinal Products ( · 2016ReviewEuropean Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monographView study →}.

Children. The EU monograph does not recommend hawthorn for heart symptoms under 18, or for stress and sleep under 12 ^{28Reference 28Committee on Herbal Medicinal Products ( · 2016ReviewEuropean Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monographView study →}.

References

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2. Pittler, M. H., Schmidt, K., & Ernst, E. (2003). Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. The American Journal of Medicine. https://pubmed.ncbi.nlm.nih.gov/12798455/
3. Holubarsch, C. J., Colucci, W. S., Meinertz, T., Gaus, W., & Tendera, M. (2008). The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial — randomised controlled trial. European Journal of Heart Failure. https://pubmed.ncbi.nlm.nih.gov/19019730/
4. Zick, S. M., Vautaw, B. M., Gillespie, B., & Aaronson, K. D. (2009). Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial — randomised controlled trial. European Journal of Heart Failure. https://pubmed.ncbi.nlm.nih.gov/19789403/
5. Zick, S. M., Gillespie, B., & Aaronson, K. D. (2008). The effect of Crataegus oxycantha special extract WS 1442 on clinical progression in patients with mild to moderate heart failure — retrospective analysis of the HERB CHF randomised controlled trial. European Journal of Heart Failure. https://pubmed.ncbi.nlm.nih.gov/18490196/
6. Szikora, Z., Mátyus, R. O., Szabó, B. V., 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. https://pubmed.ncbi.nlm.nih.gov/40732315/
7. Walker, A. F., Marakis, G., Simpson, E., Hope, J. L., Robinson, P. A., Hassanein, M., & Simpson, H. C. (2006). Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. British Journal of General Practice. https://pubmed.ncbi.nlm.nih.gov/16762125/
8. Walker, A. F., Marakis, G., Morris, A. P., & Robinson, P. A. (2002). Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytotherapy Research. https://pubmed.ncbi.nlm.nih.gov/11807965/
9. Daniele, C., Mazzanti, G., Pittler, M. H., & Ernst, E. (2006). Adverse-event profile of Crataegus spp.: a systematic review. Drug Safety. https://pubmed.ncbi.nlm.nih.gov/16752934/
10. Tankanow, R., Tamer, H. R., Streetman, D. S., et al. (2003). Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha) — randomised crossover trial in healthy volunteers, n=8. Journal of Clinical Pharmacology. https://pubmed.ncbi.nlm.nih.gov/12817526/
11. Brixius, K., Willms, S., Napp, A., et al. (2006). Crataegus special extract WS 1442 induces an endothelium-dependent, NO-mediated vasorelaxation via eNOS-phosphorylation at serine 1177 — in vitro. Cardiovascular Drugs and Therapy. https://pubmed.ncbi.nlm.nih.gov/16779533/
12. Anselm, E., Socorro, V. F. M., Dal-Ros, S., Schott, C., Bronner, C., & Schini-Kerth, V. B. (2009). Crataegus special extract WS 1442 causes endothelium-dependent relaxation via a redox-sensitive Src- and Akt-dependent activation of endothelial NO synthase — in vitro. Journal of Cardiovascular Pharmacology. https://pubmed.ncbi.nlm.nih.gov/19247189/
13. Idris-Khodja, N., Auger, C., Koch, E., & Schini-Kerth, V. B. (2012). Crataegus special extract WS 1442 prevents aging-related endothelial dysfunction — animal model. Phytomedicine. https://pubmed.ncbi.nlm.nih.gov/22621780/
14. Kim, S. H., Kang, K. W., Kim, K. W., & Kim, N. D. (2000). Procyanidins in crataegus extract evoke endothelium-dependent vasorelaxation in rat aorta — animal. Life Sciences. https://pubmed.ncbi.nlm.nih.gov/10901280/
15. Petkov, E., Nikolov, N., & Uzunov, P. (1981). Inhibitory effect of some flavonoids and flavonoid mixtures on cyclic AMP phosphodiesterase activity of rat heart — animal. Planta Medica. https://pubmed.ncbi.nlm.nih.gov/6273955/
16. Pöpping, S., Rose, H., Ionescu, I., Fischer, Y., & Kammermeier, H. (1995). Effect of a hawthorn extract on contraction and energy turnover of isolated rat cardiomyocytes — animal. Arzneimittel-Forschung. https://pubmed.ncbi.nlm.nih.gov/8929230/
17. Schüssler, M., Hölzl, J., & Fricke, U. (1995). Myocardial effects of flavonoids from Crataegus species — animal (isolated guinea-pig heart). Arzneimittel-Forschung. https://pubmed.ncbi.nlm.nih.gov/7575743/
18. Veveris, M., Koch, E., & Chatterjee, S. S. (2004). Crataegus special extract WS 1442 improves cardiac function and reduces infarct size in a rat model of prolonged coronary ischemia and reperfusion — animal model. Life Sciences. https://pubmed.ncbi.nlm.nih.gov/14761675/
19. Al Makdessi, S., Sweidan, H., Dietz, K., & Jacob, R. (1999). Protective effect of Crataegus oxyacantha against reperfusion arrhythmias after global no-flow ischemia in the rat heart — animal. Basic Research in Cardiology. https://pubmed.ncbi.nlm.nih.gov/10326654/
20. Dalli, E., Colomer, E., Tormos, M. C., et al. (2011). Crataegus laevigata decreases neutrophil elastase and has hypolipidemic effect: a randomized, double-blind, placebo-controlled trial. Phytomedicine. https://pubmed.ncbi.nlm.nih.gov/21242072/
21. Hanus, M., Lafon, J., & Mathieu, M. (2004). Double-blind, randomised, placebo-controlled study of a fixed combination of Crataegus oxyacantha and Eschscholtzia californica with magnesium in mild-to-moderate anxiety disorders. Current Medical Research and Opinion. https://pubmed.ncbi.nlm.nih.gov/14741074/
22. Song, J., Kim, D. Y., Lee, H. S., Rhee, S. Y., & Lim, H. (2024). Efficacy of a Crataegus extract mixture on body fat and lipid profiles in overweight adults: a 12-week randomized, double-blind, placebo-controlled trial. Nutrients. https://pubmed.ncbi.nlm.nih.gov/38398818/
23. Hoffmann, D. (2003). Medical herbalism: The science and practice of herbal medicine. Rochester, VT: Healing Arts Press.
24. Blumenthal, M., Brinckmann, J., & Wollschlaeger, B. (2003). The ABC clinical guide to herbs. Austin, TX: American Botanical Council.
25. Bone, K., & Mills, S. (2013). Principles and Practice of Phytotherapy. Elsevier Health. China. (Pg. 392-398).
26. Occhiuto, F., Circosta, C., Costa, R., Briguglio, F., & Tommasini, A. (1986). Comparative study of the cardiovascular activity of shoots, leaves and flowers of Crataegus oxyacantha: 2. Action of extracts and isolated pure active principles on the isolated rabbit heart. Plantes médicinales et phytothérapie, 20, 52-63.
27. British Herbal Medicine Association. (1983). British Herbal Pharmacopoeia. Bournemouth, UK: Author.
28. Committee on Herbal Medicinal Products (HMPC) (2016). European Union herbal monograph on Crataegus spp., folium cum flore (EMA/HMPC/159075/2014) — regulatory monograph. European Medicines Agency. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-crataegus-spp-folium-cum-flore_en.pdf
29. Committee on Herbal Medicinal Products (HMPC) (2016). Assessment report on Crataegus spp., folium cum flore (EMA/HMPC/159076/2014) — regulatory review. European Medicines Agency. https://www.ema.europa.eu/en/documents/herbal-report/final-assessment-report-crataegus-spp-folium-cum-flore_en.pdf
30. Phipps, J. B. Crataegus Linnaeus and Crataegus monogyna Jacquin — genus and species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae, family treatment by J. B. Phipps). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100576
31. Phipps, J. B. Crataegus laevigata (Poiret) de Candolle — species description, habitat and distribution — flora. In Flora of North America Editorial Committee (eds.), Flora of North America North of Mexico, Vol. 9 (Rosaceae). http://www.efloras.org/florataxon.aspx?flora_id=1&taxon_id=250100118

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