Hawthorn (Crataegus monogyna) is one of the most extensively studied medicinal plants of the European tradition for cardiovascular health. Its effect in mild heart failure is officially recognised, its antioxidant properties are documented in numerous studies. A 2026 review summarises the current state of knowledge – and a well-described mechanism explains how hawthorn fundamentally influences 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 approach, between 150 and 1,200 species are distinguished, due to extensive hybridisation. The main medicinally used species are Crataegus monogyna (common hawthorn) and Crataegus laevigata (midland hawthorn).
Leaves, flowers and fruits are all used medicinally. Over 300 chemical compounds have been identified in Crataegus species. The main active compound groups are oligomeric proanthocyanidins (OPC) – strongly antioxidant and vascular-protective – flavonoids including vitexin, hyperoside, rutin and quercetin, and phenolic acids with additional antioxidant activity.
Current Research: 2026 Review
A review published in January 2026 in the journal Molecules (Kępińska-Pacelik & Biel, DOI: 10.3390/molecules31020226) by researchers at the West Pomeranian University of Technology summarises the current state of hawthorn research. The authors evaluated numerous studies on cardiovascular effects, antioxidant capacity and potential as a functional food.
Key findings: hawthorn shows positive effects on blood pressure regulation, lipid metabolism and cardiac function. The polyphenol-rich extracts demonstrate strong antioxidant capacity. Anti-inflammatory, antimicrobial, lipid-lowering and antidiabetic properties have also been documented. The authors note however: "Further clinical trials and standardisation of bioactive components are needed to confirm efficacy, safety and optimal dosage."
Mechanisms of Action
Cardiac Energy Metabolism
A particularly relevant mechanism was described by Prof. Dr. Vera Regitz-Zagrosek (Charité Berlin): the heart normally generates energy from fatty acids or glucose. When fatty acids are metabolised, byproducts are formed that can promote cardiac arrhythmias under conditions of reduced oxygen supply. Hawthorn shifts this balance: the heart uses more glucose instead of fatty acids as an energy source. "By switching from fat to glucose metabolism, more energy can be released from the same amount of oxygen," explains Regitz-Zagrosek. The result: fewer exertion symptoms such as shortness of breath and rapid fatigue.
Vasodilation
Flavonoids – particularly hyperoside and rutin – stimulate the production of nitric oxide (NO) in vessel walls. NO relaxes the smooth muscle of arteries, dilates vessels and thereby reduces peripheral vascular resistance and blood pressure.
Antioxidant Protection
Oligomeric proanthocyanidins and flavonoids neutralise free radicals and protect cardiac muscle cells from oxidative stress – an important factor in the development and progression of heart disease.
Autonomic Nervous System Stabilisation
Hawthorn has a balancing effect on the autonomic nervous system, which is particularly relevant in stress-related hypertension and nervous heart complaints.
Exercise and Hawthorn: What the Evidence 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 outperformed the exercise-only group on measures of daily activity – stair climbing, gardening, housework – and self-reported quality of life. Fatigue and shortness of breath occurred less frequently. The combination was well tolerated alongside cardiac medications.
What Is Officially Recognised
Germany's Commission E and the European Medicines Agency (EMA/HMPC) have recognised the following applications:
As an approved medicinal product: declining cardiac performance corresponding to NYHA stage II (mild heart failure with slight limitation on exertion). The recommended duration of use is at least six weeks up to a maximum of six months, after which further therapy should be determined by a physician.
As a traditional herbal medicinal product: support of cardiovascular function, nervous heart complaints with tightness and palpitations (after exclusion of 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 distinguishes it from many other agents. The blood pressure-lowering effect only becomes apparent after several weeks of use – at the earliest after six to eight weeks of continuous administration.
Hawthorn in Herz essentia by Natura Nova
Herz essentia combines hawthorn extract with further traditional European plant compounds – manufactured in Switzerland to GMP standards, laboratory-tested.
Forms of Administration and Dosage
| Form | Dosage | Note |
|---|---|---|
| Tea | 1–2 g (1 tsp) per cup, 3–4× daily, steep 10–15 min | Lowest active compound concentration |
| 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 defined active compound intake |
| Finished medicinal product | As directed on packaging | Highest active compound guarantee; for NYHA-II indication |
Safety, Side Effects and Contraindications
Hawthorn is considered very well tolerated. Gastrointestinal complaints, weakness or skin rash may occasionally 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 to date. As a precaution, use alongside existing cardiac medication should be discussed with a physician.
Contraindications: Hypersensitivity to hawthorn constituents. Children and adolescents under 18 and pregnant or breastfeeding women should not take hawthorn – not because risks are known, but because systematic studies are lacking.
When to seek immediate medical attention: Chest pain radiating to the arms, upper abdomen or throat, shortness of breath at rest, or fluid retention in the legs require prompt medical assessment – these symptoms require diagnosis, not self-treatment.
Conclusion
Hawthorn is one of the most thoroughly studied medicinal plants for cardiovascular health. The 2026 review confirms the broad spectrum of effects – from antioxidant cell protection to blood pressure regulation and cardiac performance support. The energy metabolism mechanism (switching from fat to glucose metabolism) explains why hawthorn improves exercise tolerance. Hawthorn is not an emergency medication but a long-term, well-tolerated support – particularly effective in combination with regular physical activity. Acute or unexplained cardiac symptoms always require medical assessment first.
This article is for general information purposes only and does not replace medical advice. Food supplements are not a substitute for a varied and balanced diet.
References
- Kępińska-Pacelik J, Biel W (2026). Hawthorn (Crataegus monogyna Jacq.): A Review of Therapeutic Potential and Applications. Molecules, 31(2), 226. DOI: 10.3390/molecules31020226
- Härtel S, Kutzner C, Westphal E et al. (2014). Effects of endurance exercise training and Crataegus extract WS® 1442 in patients with heart failure with preserved ejection fraction. Sports, 2(3), 59–75.
- Holubarsch CJF, Colucci WS, Eha J (2018). Benefit-risk assessment of Crataegus extract WS 1442. American Journal of Cardiovascular Drugs, 18, 25–36.
- EMA/HMPC: European Union herbal monograph on Crataegus spp., folium cum flore. EMA/HMPC/159075/2014.
