Does hawthorn help the heart? What to ask your doctor

The honest answer is: possibly a little, in one narrow situation, and it is not a substitute for heart care. A Cochrane review of placebo-controlled trials found that hawthorn leaf and flower extract, used alongside usual treatment, was linked to better exercise capacity and fewer symptoms in people with chronic heart failure. The NIH says the evidence is conflicting, and that there is not enough to say hawthorn affects heart disease, chest pain, abnormal heartbeat or artery plaque. If you take heart or blood pressure medicine, talk to your doctor or pharmacist before adding it.

This guide covers what the trials tested, the safety and drug-interaction questions, how supplements that contain hawthorn describe it, and a list of questions to bring to your appointment. It is general information, not medical advice.

What is hawthorn, and why is it sold for the heart?

Hawthorn is a flowering shrub or tree of the rose family. The NIH National Center for Complementary and Integrative Health (NCCIH) says it was traditionally used for heart disease, digestion and circulation, and today it is promoted for the heart and blood vessels, weight loss and anxiety. In supplements you will see it as hawthorn berry, leaf, flower or "extract", and the plant part matters, because the best-studied products are extracts of leaf with flower.

A 2010 review in American Family Physician says the active components are thought to be flavonoids and oligomeric procyanidins, and that the most studied extracts have lab codes: WS 1442 and LI 132. That detail is useful when you read a label. A standardized extract with a code is not the same product as an unspecified berry powder.

What did the heart trials actually show?

The main evidence is on chronic heart failure, a condition where the heart cannot pump as much blood as it should. A Cochrane review published in 2008 included 14 randomized, double-blind, placebo-controlled trials of hawthorn leaf and flower extracts. In most of them, hawthorn was added to conventional treatment. Ten trials with 855 people provided data that could be pooled.

For maximal workload, hawthorn beat placebo by about 5 watts on average. Exercise tolerance and shortness of breath and fatigue also improved significantly compared with placebo. The reported side effects were infrequent, mild and temporary, and included nausea, dizziness, and heart and stomach complaints. The reviewers concluded there is a significant benefit in symptom control and physical measures as an add-on treatment.

Here is what that review did not show. It found no real data on deaths or cardiac events, other than one trial that reported four deaths (three in the hawthorn group, one in the control group) without details. The American Family Physician review says likewise that there is no evidence of a notable reduction in mortality or sudden death, and that proven conventional therapies for heart failure are still recommended until safety and effectiveness are shown in long-term studies.

The NCCIH page describes the picture as conflicting for heart failure, with not enough evidence for other heart conditions. We did not find a source we could open that supports hawthorn as a stand-alone way to lower blood pressure, so we will not claim that it does.

Is hawthorn safe, and does it interact with medicines?

Hawthorn products appear to be tolerated well in short trials. NCCIH says some hawthorn supplements might be safe in the short term, but no research has tested whether it is safe for more than 16 weeks. Side effects can include dizziness, nausea, vomiting, diarrhea and muscle pain, and little is known about use during pregnancy or breastfeeding.

The same page raises a specific concern: one study indicated that a particular hawthorn preparation may have caused an early risk of heart failure progression in patients. It is unclear why, but one possibility is an interaction with drugs the patients were taking.

The interaction question is the one to take seriously. The American Family Physician review lists theoretical interactions with antiarrhythmics, blood pressure drugs, digoxin and cholesterol drugs. On digoxin, the research is mixed. A 2003 crossover trial of 8 healthy volunteers gave digoxin 0.25 mg alone, then with the WS 1442 extract at 450 mg twice a day for 21 days, and found no significant change in how the body handled digoxin. A 2010 lab study found that hawthorn interfered with one brand of digoxin blood test and, using isolated rat heart cells, suggested that the two act on the same target. Its authors advised that a patient receiving digoxin should avoid hawthorn.

The lesson is not that one study is right. It is that this is a question for a prescriber who knows your medicine list.

What is the warning about tejocote root?

NCCIH notes that in January 2024 the FDA published a list of products, including dietary supplements labeled "tejocote root" (Mexican hawthorn), that actually contain yellow oleander, a toxic plant. The FDA warned the products may cause severe harm or even be fatal. Some people had been taking them for weight loss. NCCIH adds that there is no evidence that hawthorn affects weight loss.

If a product sold as a hawthorn or "heart" supplement is labeled tejocote, or sold as a weight loss root, that is a reason to stay away, not a reason to compare prices.

How do supplements that contain hawthorn handle the dose?

Hawthorn turns up in many formulas, often as one of several herbs. The Cardio Shield review covers a blood pressure formula where hawthorn leaf extract shares a single 570 mg proprietary blend with olive leaf, nattokinase, green tea, garlic and hibiscus. No ingredient has its own amount, so you cannot compare it with the extract doses in trials. It does have a 180-day refund, which our review counts as a real strength.

The Bazopril review goes further: the page discloses no capsule count, serving size or milligram amount for any of its six ingredients. It does have a 365-day refund, and costs $49 to $69 a month.

The Blood Pressure 911 review flags seven herbs, including hawthorn, in one 620 mg blend, and testimonials that describe stopping prescriptions. Changing blood pressure medicine without a doctor can be dangerous. Our review says plainly that we would not buy it for blood pressure.

Not every hawthorn dose is hidden. The Protoflow review shows 250 mg of hawthorn fruit in a prostate formula, and notes that hawthorn research is about heart function, not the prostate. For more offers, browse the heart health category.

Questions to ask your doctor or pharmacist

1. I take (list your medicines). Could hawthorn interact with any of them?
2. Do I take digoxin, a blood pressure drug or an antiarrhythmic? Should I avoid hawthorn completely?
3. Will hawthorn change any blood test or monitoring I have coming up?
4. If I try it, which product form and how long, given the studies ran about 16 weeks at most?
5. What symptoms (dizziness, a change in heartbeat, new swelling) mean I should stop and call you?
6. Is my heart or blood pressure plan working, and what else should we change?

Also check the label for the plant part, any standardized extract code, and whether the dose is printed. Our review method scores offers on exactly those points.

FAQ

Does hawthorn help the heart?

In heart failure trials, hawthorn leaf and flower extract added to usual treatment improved exercise capacity and symptoms in a Cochrane review. The NIH says evidence for other heart conditions is not sufficient, and no mortality benefit was shown.

Can you take hawthorn with blood pressure medicine?

Ask your prescriber first. A medical review lists theoretical interactions with blood pressure drugs, digoxin, antiarrhythmics and cholesterol drugs. Do not stop or change prescribed medicine on the advice of a sales page.

What are the side effects of hawthorn?

NCCIH lists dizziness, nausea, vomiting, diarrhea and muscle pain. Safety beyond 16 weeks has not been tested, and use in pregnancy is not well studied.

Is tejocote root the same as hawthorn?

Tejocote is a Mexican hawthorn, but NCCIH says the FDA found some products labeled tejocote root actually contained toxic yellow oleander. Avoid them.