Hawthorn (Crataegus species), a member of the rose family, was hung over the doorway in the Middle Ages to prevent the entry of evil spirits. By the early 1800's, American physicians recognized the herb's medicinal properties and began using it to treat circulatory disorders and respiratory illnesses. Considered a "cardiotonic" herb, the flowers and berries of the hawthorn plant have been used in traditional medicine to treat irregular heartbeat, high blood pressure, chest pain, hardening of the arteries, and congestive heart failure.

Animal and laboratory studies have found that hawthorn contains active compounds with antioxidant properties. Antioxidants are substances that scavenge free radicals -- damaging compounds in the body that alter cell membranes, tamper with DNA, and even cause cell death. Free radicals occur naturally in the body, but environmental toxins (including ultraviolet light, radiation, cigarette smoking, and air pollution) can also increase the number of these damaging particles. Free radicals are believed to contribute to the aging process as well as the development of a number of health problems including heart disease. Antioxidants found in hawthorn can neutralize free radicals and may reduce or even help prevent some of the damage they cause. Today, many professional herbalists believe that the antioxidants in hawthorn may help protect against heart disease and help control high blood pressure and high cholesterol.

Congestive heart failure
Hawthorn has primarily been studied in people with congestive heart failure (a health condition in which the heart is unable to pump adequate amounts of blood to other organs in the body). Of six well-designed trials, four studies concluded that hawthorn significantly improved heart function and three found that the herb improved patients' ability to exercise. Patients in five of the six studies reported that hawthorn significantly improved symptoms of the disease (such as shortness of breath and fatigue). One study found that hawthorn extract (900 mg/day) taken for 2 months was as effective as low doses of captropril (a leading heart medication) in improving symptoms of congestive heart failure. A large-scale international study is currently underway to determine whether hawthorn extract reduces the risk of death in people with this disease. Results are expected at the end of 2002.

Atherosclerosis
Animal and laboratory studies demonstrate that this herb has antioxidant properties that help protect against the formation of plaques, which leads to a health problem known as atherosclerosis. Plaque buildup in the vessels that supply the heart with oxygen-rich blood may cause chest pain (angina) and heart attacks while plaque buildup in the arteries that supply blood to the brain may result in stroke.

Chest pain
Hawthorn berry preparations have been shown to combat chest pain (angina), a health problem caused by insufficient blood flow to the heart. In one early study, 60 angina patients were given either 180 mg/day of hawthorn berry-leaf-flower extract or placebo for 3 weeks. Those who received the hawthorn preparation experienced improved blood flow to the heart and were also able to exercise for longer periods of time without suffering from chest pain.

High cholesterol
Studies using rats suggest that a hawthorn tincture (made from the berries) may be a powerful agent for the removal of LDL ("bad") cholesterol from the bloodstream. The tincture of hawthorn berries also reduced the production of cholesterol in the liver of rats who were being fed a high-cholesterol diet. Studies to determine if hawthorn will confer the same effects in people are needed.

High blood pressure
Although hawthorn has not been studied specifically in people with high blood pressure, considerable evidence supports the cardiovascular benefits of this herb. Studies suggest that hawthorn can be taken safely by people with hypertension who are also taking blood pressure medications.

Hawthorn is a common thorny shrub that grows up to five feet tall on hillsides and in sunny wooded areas throughout the world. In May its flowers bloom, but even though hawthorn is in the same botanical family as roses, the flowers are not fragrant. They grow in small clusters, and are white, red, or pink. Small berries, called haws, sprout after the flowers. They are usually red when ripe, but they may also be black. Hawthorn leaves are shiny and grow in a variety of shapes and sizes.

Hawthorn contains many substances that may benefit the heart. However, it appears that two substances in particular -- flavonoids and oligomeric procyanidins (OPCs) -- are most likely to contribute to hawthorn's beneficial effects on the heart. Flavonoids help dilate blood vessels, improve blood flow, and increase heart rate. Both flavonoids and OPCs have potent antioxidant effects.

The berries, leaves, and flowers of the hawthorn plant are used for medicinal purposes. The leaves and flowers are believed to contain substantially more of the active compounds than the berries.

Hawthorn is available in capsules, tinctures, standardized fluid extracts, or solid extracts. A bitter-tasting tea can also be made from dried hawthorn leaves, flowers, and berries.

Pediatric

There are no known scientific reports on the pediatric use of hawthorn. Therefore, it is not currently recommended for children.

Adult

To decrease symptoms of congestive heart failure (which has been the most studied use for hawthorn):

• 160 to 900 mg standardized (4 to 20 mg flavonoids/30 to 160 mg oligomeric procyanidins) fluid crude extract daily for at least six weeks
• 120 to 240 mg extract standardized to 1.8% vitexin rhamnoside/10% procyanidins three times per day for at least six weeks. 

Hawthorn for heart failure or angina may require at least six weeks of use, three times per day before an effect is noticed.

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, contain active substances that can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a practitioner knowledgeable in the field of botanical medicine.

The American Herbal Products Association (AHPA) gives hawthorn a class 1 safety rating, which indicates that it is a very safe herb with a wide dosage range. Even so, it is always wise to follow recommended dosages. Side effects are rare, but may include headache, nausea, and palpitations (a feeling of a racing heart).

If you are pregnant or breastfeeding, do not use hawthorn.

It is extremely important for you to note any changes you feel while you are taking hawthorn. People experiencing more pain, more angina attacks, more exhaustion while walking or exercising should stop taking hawthorn and seek immediate medical attention. Even if you don't experience any of these symptoms, see your healthcare provider if your condition hasn't improved after six weeks of hawthorn treatment. Your progress should always be monitored by your healthcare provider.

If you are currently being treated with any of the following medications, you should not use hawthorn without first talking to your healthcare provider:

Digoxin
Hawthorn may enhance the activity of digoxin, a medication used for irregular heart rhythms.

Phenylephrine
In a laboratory study, an alcoholic extract of hawthorn fruit counteracted the effects of phenylephrine, a medication that constricts blood vessels and is commonly found in nasal decongestant products. However, this interaction has not been studied in people; therefore, the relevance of this interaction to people is unknown at this time.

Bahorun T, Trotin F, Pommery J, Vasseur J, Pinkas M. Antioxidant activities of Crataegus monogyna extracts. Planta Med. 1994;60:323-328.

Blumenthal M, Goldberg A, Brinckmann J. Herbal Medicine: Expanded Commission E Monographs. Newton, MA: Integrative Medicine Communications; 2000:182-192.

Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy, Ore: Eclectic Medical; 1998:82-83.

Foster S, Tyler VE. Tyler's Honest Herbal. 4th ed. New York: The Haworth Herbal Press; 1999:205-207.

Fugh-Berman A. Herbs and dietary supplements in the prevention and treatment of cardiovascular disease. Prev Cardiol. 2000;3(1):24-32.

Holubarsch CJ, Colucci WS, Meinertz T, Gaus W, Tendera M. Survival and prognosis: investigation of Crataegus extract WS 1442 in congestive heart failure (SPICE)--rationale, study design and study protocol. Eur J Heart Fail. 2000;2(4):431-437.

Karch SB. The Consumer's Guide to Herbal Medicine. Hauppauge, New York: Advanced Research Press; 1999:109-111.

Mashour NH, Lin GI, Frishman WH. Herbal medicine for the treatment of cardiovascular disease. Arch Intern Med. 1998;158:2225–2234.

Miller AL. Botanical influences on cardiovascular disease. Altern Med Review. 1998;3(6):422-431.

Miller L. Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 1998;158(20):2200–2211.

Morelli V, Zoorob RJ. Alternative therapies: Part II. Congestive heart failure and hypercholesterolemia. [Review]. Am Fam Physician. 2000;62(6):1325-1330.

Rajendran S, Deepalakshmi PD, Parasakthy K, Devaraj H., Devaraj SN. Effect of tincture of Crataegus on the LDL-receptor activity of hepatic plasma membrane of rats fed an atherogenic diet. Atherosclerosis. 1996;123:235-241.

Rotblatt M, Ziment I. Evidence-Based Herbal Medicine. Philadelphia, PA: Hanley & Belfus, Inc; 2002:231-235.

Rigelsky JM, Sweet BV. Hawthorn: pharmacology and therapeutic uses. Am J Health Syst Pharm. 2002;59(5):417-422.

Schultz V, Hansel R, Tyler V. Rational Phytotherapy: A Physician's Guide to Herbal Medicine. Heidelberg: Springer; 1998.

Schussler M, Holzl J, Fricke U. Myocardial effects of flavonoids from crataegus species. Arzneimittelforschung. 1995;45:842–845.

White L, Mavor S. Kids, Herbs, Health. Loveland, Colo: Interweave Press; 1998:22.