Hawthorn (Crataegus)

We evaluated 19 human studies on Hawthorn (Crataegus), including 4 randomised controlled trials and 5 meta-analyses or systematic reviews; the controlled studies include 283 participants in total. As of 11 October 2026.

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1. What Is Hawthorn (Crataegus)? Occurrence, Origin and Forms

Hawthorn (Crataegus) is a genus of shrubs and small trees in the rose family (Rosaceae). The species used medicinally in Europe include common hawthorn (Crataegus monogyna) and midland hawthorn (Crataegus laevigata). Its leaves, flowers and fruits have traditionally been used for cardiovascular complaints.

Hawthorn grows in Europe, parts of Asia and North America along woodland edges, in hedgerows and thickets. Many species are also planted as ornamentals and hedging plants.

For use, leaves with flowers are collected at flowering time and fruits in autumn, then dried and processed into extracts, usually dry extracts made with water-alcohol mixtures. Human studies mainly examine standardised dry extracts from leaves with flowers and from fruits.

Forms and Preparations Studied

• Dried leaves with flowers
• Dried fruits
• Dry extract from leaves with flowers
• Dry extract from fruits
• Infusion (tea)
• Liquid extract (tincture)

Not covered on this page:

• Plants containing cardiac glycosides and heart medicines, such as preparations from foxglove (Digitalis purpurea), are separate substances and not hawthorn studies.
• Mixtures of hawthorn with other plants, such as mistletoe (Viscum album) or garlic (Allium sativum), do not count as hawthorn alone.
• Ornamental forms of the genus Crataegus that do not belong to the medicinally used species are not the subject of this page.
• Other thorny shrubs such as blackthorn (Prunus spinosa) are confused with hawthorn but are a different plant.

2. What Does Hawthorn (Crataegus) Do? Results by Area

How to read the table: counted are human studies whose results concern the area. “High” means at least one meta-analysis and two controlled studies showing improvement, or at least three controlled studies of which three quarters show improvement, with at least 300 participants in total. “Moderate” means at least two controlled studies showing improvement, as a majority, or one meta-analysis alongside controlled studies. “Low” means one controlled study showing improvement. Where an area has no controlled study, the strength of evidence is at most “low” (result “reviews only” or “observational data only”). Everything else is “unclear”. A study counts as showing improvement when at least half of its outcomes in this area improved. Reviews of combination products do not count as meta-analyses; results that only describe side effects or shares of users do not count as an effect. The same study is counted only once.

3. What the Studies Show in Detail

Hawthorn (Crataegus) and Heart Failure: Human Studies

In chronic heart failure, a systematic review of hawthorn leaf-with-flower dry extract as a monopreparation showed improvements in maximum performance in the exercise test, exercise tolerance, the rate-pressure product as well as symptoms such as shortness of breath and fatigue compared with placebo, mostly in addition to conventional therapy 1. A more recent randomized controlled trial in addition to standard therapy, by contrast, found no difference in the primary endpoint 6-minute walk distance, only a slightly higher ejection fraction 7. The strength of evidence is moderate: the positive findings come from a review of older studies; the more recent single study found no benefit for symptoms and exercise capacity. Only dry extract from leaves with flowers was studied, not from fruits; dose and standardization differ by preparation and are stated in the study cards. Statements on other preparation forms, on longer-term course and on transferability to patients outside the studied NYHA classes remain open.

Hawthorn (Crataegus) and Blood Pressure: Human Studies

A meta-analysis of placebo-controlled trials in high blood pressure found lower systolic blood pressure with hawthorn; for diastolic, the difference was not confirmed 2. A randomized controlled trial in heat-exposed shift workers found lower systolic and diastolic values with a hawthorn drink with vitamin C than with salt water; this applies to the mixture, not to hawthorn alone 9. The evidence is low: for hawthorn alone, only the meta-analysis is available, and a separate controlled individual study is lacking. Different forms were studied, whose type, plant part and standardization are not uniformly named; it remains open which preparation and which hawthorn species carry the observed effect.

Hawthorn (Crataegus) and Quality of Life: Human Studies

In people with diabetes and inflammation of the oral mucosa, oral health-related quality of life improved more with rinses of diluted hawthorn vinegar than with green tea 6. A randomized controlled trial in outpatients with chronic heart failure of NYHA class II–III, by contrast, found no difference in quality of life compared with placebo under a dry extract from leaves with flowers in addition to standard therapy 7. A randomized controlled crossover trial in subjectively stressed but otherwise healthy adults showed, for a combination preparation of Crataegus laevigata fruit extract with Scutellaria baicalensis root extract, magnesium and chromium, an improvement in mood, anxiety and social satisfaction; this statement applies to the mixture, not to hawthorn alone 8. The evidence is unclear: the three controlled trials study different populations, plant parts and preparations, and none is available as a meta-analysis. It remains open whether the findings of the combination preparation are transferable to hawthorn alone.

Hawthorn (Crataegus): Further Outcomes in Studies

In people with diabetes, inflammation of the oral mucosa decreased more with rinses of diluted hawthorn vinegar than with green tea 6. A combination preparation of hawthorn fruits, Baikal skullcap, magnesium and chromium improved attention and working memory in stressed adults in a placebo-controlled study 8. The strength of evidence is unclear because the findings come from only a few controlled studies with different preparations, populations and comparison groups. A meta-analysis compared Chinese herbal mixtures containing hawthorn for elevated blood lipids with standard medications; its results apply to the mixtures, not to hawthorn alone 3. For hawthorn as a single preparation in cardiovascular diseases, the data are inconsistent 12. An overview lists hawthorn among many medicinal plants used against stress in coronary heart disease 13. Regarding drug interactions and further applications, the data are unclear 1819.

Further studies in this area: 15 16 18 19

4. How Is Hawthorn (Crataegus) Dosed? Preparation, Dose and Duration in Studies

The studies mainly used extract from leaves with flowers, as well as diluted hawthorn vinegar as a mouth rinse, fruit extract in a combination preparation, and a hawthorn drink. Leaf-with-flower extracts and fruit extracts are not interchangeable; species, plant part, dose and standardization differ by preparation and are stated in the study cards. Some studies tested hawthorn only as a component of a mixture with other plants or additives.

5. Is Hawthorn (Crataegus) Safe? Side Effects in Studies

In a randomized controlled trial in heart failure patients, more adverse events occurred with the leaf-with-flower extract than with placebo, mostly non-cardiac 7. Hawthorn can enhance the effect of anticoagulants, digoxin and blood pressure-lowering drugs 19; a review also mentions a bleeding risk during operations 15. In the placebo studies of the systematic review, side effects were rare, mild and temporary, such as nausea and dizziness 1.

6. What Remains Open: Limits of the Evidence

• Whether hawthorn alleviates symptoms in addition to today's heart failure therapy is open; the more recent study found no benefit 7.
• It is open which preparation and which hawthorn species carry the observed blood pressure effect.
• The transferability of findings on combination preparations to hawthorn alone is unclear.
• Statements on longer-term course and on patients outside the studied NYHA classes are lacking.
• Drug interactions and further uses have hardly been studied.

7. Bottom Line: What Is Established About Hawthorn (Crataegus)

Hawthorn is best studied as a dry extract from leaves with flowers. The evidence is moderate for heart failure, otherwise low or unclear, and relies mainly on review articles.

The data are inconsistent: a systematic review of older placebo studies found better exercise tolerance and fewer symptoms in heart failure 1. A more recent randomized controlled trial in addition to standard therapy, by contrast, showed no benefit for walking distance and quality of life, but more adverse events than placebo 7. Further positive findings concern combination preparations and do not apply to hawthorn alone 89. The data on tolerability, interactions and further applications are limited 1819.