Hawthorn (Crataegus monogyna) is one of the best-studied medicinal plants in European tradition for heart health. Its use in early-stage heart failure is officially recognised, and its antioxidant properties are documented in numerous studies. A 2026 review summarises the current state of knowledge — and a newly described mechanism helps explain how hawthorn fundamentally affects the heart's energy supply.
The plant and its active compounds
Hawthorn belongs to the rose family (Rosaceae) and is widespread across Europe, Asia and North America. The genus Crataegus is taxonomically complex — depending on the classification approach, anywhere from 150 to 1,200 species are distinguished, largely due to extensive hybridisation. The two species most used medicinally are Crataegus monogyna (one-seeded hawthorn) and Crataegus laevigata (two-seeded hawthorn).
Leaves, flowers and fruit are all used. More than 300 chemical compounds have been identified in Crataegus species. The main groups of active compounds are oligomeric procyanidins (OPCs), strongly antioxidant and vessel-protective; flavonoids — particularly vitexin, hyperoside, rutin and quercetin; and phenolic acids with additional antioxidant activity.
Current research: the 2026 review
A review published in January 2026 in the journal Molecules (Kępińska-Pacelik & Biel, DOI: 10.3390/molecules31020226) from the West Pomeranian University of Technology summarises the current state of research. The authors evaluated numerous studies on cardiovascular effects, antioxidant capacity, and hawthorn's potential as a functional food.
The key findings: hawthorn shows positive effects on blood pressure regulation, lipid metabolism and cardiac function. Its polyphenol-rich extracts show strong antioxidant capacity. Anti-inflammatory, antimicrobial, lipid-lowering and antidiabetic properties have also been documented. The authors stress, however, that "further clinical trials and standardization of bioactive components are needed to confirm efficacy, safety, and optimal dosage."
Mechanisms of action
The heart's energy metabolism
A particularly relevant mechanism has been described by Prof. Dr. Vera Regitz-Zagrosek of Charité Berlin: the heart normally draws energy from fatty acids or sugar. Breaking down fatty acids produces metabolic by-products that, when oxygen is scarce in the heart muscle, can promote cardiac arrhythmias. Hawthorn shifts this balance: the heart uses more sugar rather than fatty acids as an energy source. "By switching from fat to sugar metabolism, more energy can be released using the same amount of oxygen," explains Regitz-Zagrosek. The result: fewer exertion-related symptoms such as breathlessness and quicker exhaustion.
Vasodilation
Flavonoids — particularly hyperoside and rutin — stimulate the production of nitric oxide (NO) in the vessel walls. NO relaxes the smooth muscle of the arteries, widening the vessels and thereby lowering peripheral vascular resistance and blood pressure.
Antioxidant protection
Oligomeric procyanidins and flavonoids neutralise free radicals and protect heart muscle cells from oxidative stress — an important factor in the development and progression of heart disease.
Stabilising the autonomic nervous system
Hawthorn has a balancing effect on the autonomic nervous system, which is particularly relevant for stress-related high blood pressure and nervous heart complaints.
Exercise and hawthorn: what the research shows
A randomised controlled trial (Härtel, Kutzner, Westphal et al., Sports 2014; 2(3): 59–75) examined the combination of endurance training and standardised hawthorn extract (WS® 1442) in patients with heart failure with preserved ejection fraction. The hawthorn group performed better than the training-only group on everyday activities — climbing stairs, gardening, housework — and on self-rated quality of life. Fatigue and shortness of breath occurred less often. The combination was also well tolerated alongside cardiac medication.
What is officially recognised
Commission E and the European Medicines Agency (EMA/HMPC) have recognised the following uses:
- As an authorised medicinal product: declining cardiac performance corresponding to NYHA stage II (early-stage heart failure with mild limitation on exertion). The recommended duration of use is at least six weeks and up to six months, after which further therapy should be determined by a doctor.
- As a traditional herbal medicinal product: support for heart and circulatory function, nervous heart complaints with a feeling of tightness and palpitations (after ruling out serious causes), and mild symptoms of nervous tension and difficulty falling asleep.
Blood pressure regulation
Hawthorn shows a regulating effect on both elevated and low blood pressure — a property that sets it apart from many other active substances. However, the blood-pressure-lowering effect only sets in after several weeks of use — at the earliest after six to eight weeks of continuous intake.
Herz essentia by Natura Nova
Herz essentia combines hawthorn extract with further traditional European plant compounds — manufactured in Switzerland to GMP standards, lab-tested.
Forms and dosage
| Form | Dosage | Note |
|---|---|---|
| Tea | 1–2 g (1 tsp) per cup, 3–4× daily, steep 10–15 min | Weakest concentration of active compounds |
| Tincture / drops | 10–15 drops, 1–3× daily, diluted in water | 15 min before meals |
| Capsules / tablets (standardised) | 600–900 mg daily | Guaranteed flavonoid and OPC content; for a defined intake of active compounds |
| Licensed medicinal product | As per package instructions | Highest guarantee of active-compound content; for the NYHA II indication |
Safety, side effects and contraindications
Hawthorn is considered very well tolerated. Rarely, gastrointestinal complaints, a feeling of weakness or skin rash can occur. At very high doses, cardiac arrhythmias and a drop in blood pressure are possible.
Interactions: no clinically relevant interactions with cardiac medications have been documented so far. As a precaution, use alongside existing cardiac medication should be discussed with a doctor.
Contraindications: hypersensitivity to hawthorn compounds. Children and adolescents under 18, as well as pregnant and breastfeeding women, should not take hawthorn — not because risks are known, but because systematic studies are lacking.
When to see a doctor immediately: pain in the chest area radiating to the arms, upper abdomen or throat, breathlessness at rest, or fluid retention in the legs require immediate medical assessment — these symptoms call for a diagnosis, not self-treatment.
Conclusion
Hawthorn is one of the best-studied medicinal plants for heart health. The 2026 review confirms its broad range of effects — from antioxidant cell protection to blood pressure regulation to supporting cardiac performance. The energy-metabolism mechanism (shifting from fat to sugar metabolism) helps explain why hawthorn improves exercise tolerance. Hawthorn is not an emergency medication but a long-term, well-tolerated support — particularly effective in combination with regular exercise. For acute or unclear heart complaints, medical assessment is always the first step.
This article is intended for general information and does not replace medical advice. Food supplements are not a substitute for a balanced and varied diet.
Sources
- Kępińska-Pacelik J, Biel W: Hawthorn (Crataegus monogyna Jacq.): A Review of Therapeutic Potential and Applications. Molecules. 2026;31(2):226. doi: 10.3390/molecules31020226 (PMC, Open Access)
- Härtel S, Kutzner C, Westphal E, Limberger M, Burkart M, Ebner-Priemer U, Kohl-Bareis M, Bös K: Effects of endurance exercise training and Crataegus extract WS® 1442 in patients with heart failure with preserved ejection fraction – a randomized controlled trial. Sports. 2014;2(3):59–75. doi: 10.3390/sports2030059 (Open Access)
- Holubarsch CJF, Colucci WS, Eha J: Benefit-risk assessment of Crataegus extract WS 1442: an evidence-based review. Am J Cardiovasc Drugs. 2018;18(1):25–36. doi: 10.1007/s40256-017-0249-9 (PMC, Open Access)
- European Medicines Agency (EMA/HMPC): European Union herbal monograph on Crataegus spp., folium cum flore. EMA/HMPC/159075/2014.
