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Hawthorn Berry
Hawthorn is a serious clinical phytotherapeutic in Germany used as an add-on for chronic heart failure under physician care.
- Evidence
- Mixed Evidence
- Category
- Heart & Cardiovascular
- Best form
- WS 1442 standardized leaf-and-flower extract (Crataegutt by Dr. Willmar Schwabe, used in essentially all Cochrane-reviewed CHF trials)
- Effective dose
- 900-1800mg/day of standardized WS 1442 extract (4-7:1, ethanolic extract standardized to oligomeric procyanidins) split twice daily. Most clinical trials used 900mg/day
- Lab tested
- 2 of 8 products
- Category
- Heart & Cardiovascular
- Best form
- WS 1442 standardized leaf-and-flower extract (Crataegutt by Dr. Willmar Schwabe, used in essentially all Cochrane-reviewed CHF trials)
- Effective dose
- 900-1800mg/day of standardized WS 1442 extract (4-7:1, ethanolic extract standardized to oligomeric procyanidins) split twice daily. Most clinical trials used 900mg/day
- Lab tested
- 2 of 8 products
Key takeaways
- →The only well-evidenced use case is adjunct therapy for chronic heart failure (NYHA II-III) under physician supervision, using standardized WS 1442 extract at 900-1800mg/day.
- →The 14-trial Cochrane meta-analysis (n=855) shows modest symptom and workload gains; the largest single trial (SPICE, n=2,681) did not confirm a mortality benefit; the US HERB CHF trial (n=120) was negative.
- →WS 1442 is the trial-grade extract; most US supplement-aisle products do not specify WS 1442 or publish a procyanidin standardization, which is the biggest product-quality variable.
- →Real drug interactions: hawthorn can potentiate digoxin's effect on the heart, has additive bradycardia and hypotension with beta-blockers and nitrates, and additive BP-lowering with antihypertensives. Do not start hawthorn without telling the prescriber.
- →For general 'heart health' or mild hypertension in healthy adults, the evidence is thin; the marketing claim is well ahead of the data.
What Is Hawthorn Berry?
Hawthorn is a serious clinical phytotherapeutic in Germany used as an add-on for chronic heart failure under physician care. The 2008 Cochrane review by Pittler and colleagues pooled 14 trials with 855 patients and found that standardized hawthorn extract (almost always WS 1442) added to conventional heart failure therapy produced modest but real gains: maximal workload improved by about 5 watts versus placebo, pressure-rate product fell, and patient-reported symptoms improved. That is the only well-evidenced use case for hawthorn, and it is a use case the average US supplement buyer should not be self-managing.
The story gets more complicated with the bigger trials. The 2008 SPICE trial (Holubarsch et al.) randomized 2,681 NYHA II-III heart failure patients to WS 1442 or placebo on top of standard therapy for 24 months. The primary composite endpoint (time to first cardiac event) was not significantly different. There was a numerical trend toward reduced cardiac mortality (9.7% relative reduction, p=0.269) and a subgroup signal of reduced sudden cardiac death in patients with less severe LV dysfunction. The largest, best-powered trial therefore did not confirm a survival benefit but did not refute the symptomatic benefit either. The US-based HERB CHF trial (Zick 2009, n=120, 900mg/day for 6 months) was flatly negative on exercise tolerance and quality of life and noted more adverse events in the hawthorn arm.
For mild hypertension and general "heart health," the consumer-facing claim, the evidence is thin. Walker 2002 (n=36) found a non-significant diastolic trend at 10 weeks. Walker 2006 (n=79 patients with type 2 diabetes) found a significant diastolic reduction but no systolic effect. These are small pilot trials and the effect sizes are modest. Hawthorn is not a substitute for first-line antihypertensives.
The mechanism is plausible. Crataegus oligomeric procyanidins and flavonoids show positive inotropic effects on heart muscle in animal and isolated-tissue work, increase coronary blood flow, and have mild vasodilator activity. The WS 1442 fingerprint is dominated by oligomeric procyanidins and standardized to 18.75% of these compounds; most US supplement-aisle products do not specify WS 1442 and do not publish a procyanidin or vitexin standardization, which is the single biggest product-quality variable a consumer faces.
Practical bottom line: if you have diagnosed chronic heart failure and your cardiologist is willing to consider an adjunct phytotherapeutic, 900mg/day of a WS 1442 extract is the form with the trial data. If you want hawthorn for general heart support or mild BP, the evidence is weak, the drug interactions are real (digoxin, beta-blockers, nitrates, antihypertensives), and you should talk to your prescriber first.
Does It Work? The Evidence
How A-F grades workChronic heart failure (NYHA II-III) symptoms and exercise capacity, as add-on to standard therapy
Pittler 2008 Cochrane review of 14 RCTs (n=855): maximal workload +5.35 watts (p<0.02), symptoms improved -5.47 on combined symptom scale; Tauchert 2002 (n=209, NYHA III): 1800mg WS 1442 significantly increased maximal workload vs placebo and vs 900mg; Tauchert 1999 (n=1,011, NYHA II): 900mg WS 1442 reduced fatigue, dyspnea, and ankle edema over 24 weeks
All-cause and cardiac mortality in chronic heart failure
Holubarsch 2008 SPICE trial (n=2,681, NYHA II-III, 24 months): time to first cardiac event not significantly different (620 vs 606 days); cardiac mortality trend not significant (p=0.269); subgroup signal of reduced sudden cardiac death in patients with LVEF 25-35%
Exercise tolerance and quality of life in NYHA II-III heart failure (US population)
Zick 2009 HERB CHF trial (n=120, 900mg/day x 6 months): no significant improvement in 6-minute walk distance or Minnesota Living with Heart Failure quality-of-life score vs placebo; more adverse events in hawthorn arm
Mild hypertension (blood pressure reduction)
Walker 2002 pilot RCT (n=36 mildly hypertensive adults): non-significant diastolic trend (p=0.081) at 10 weeks; Walker 2006 RCT (n=79 type 2 diabetics on prescription drugs): significant diastolic reduction vs placebo (p=0.035), no effect on systolic BP
General 'heart health' / cardiovascular prevention in healthy adults
No RCTs of hawthorn in healthy adults for primary cardiovascular prevention; mechanistic and pre-clinical data only
Anxiety and stress
Hanus 2004 RCT of a fixed combination (hawthorn + California poppy + magnesium) suggested anxiety reduction but the hawthorn-specific contribution is not isolable; no hawthorn-monotherapy RCT for anxiety
| Grade | Claimed Benefit | Key Studies | Our Verdict |
|---|---|---|---|
| B | Chronic heart failure (NYHA II-III) symptoms and exercise capacity, as add-on to standard therapy | Pittler 2008 Cochrane review of 14 RCTs (n=855): maximal workload +5.35 watts (p<0.02), symptoms improved -5.47 on combined symptom scale; Tauchert 2002 (n=209, NYHA III): 1800mg WS 1442 significantly increased maximal workload vs placebo and vs 900mg; Tauchert 1999 (n=1,011, NYHA II): 900mg WS 1442 reduced fatigue, dyspnea, and ankle edema over 24 weeks | Supported |
| B | All-cause and cardiac mortality in chronic heart failure | Holubarsch 2008 SPICE trial (n=2,681, NYHA II-III, 24 months): time to first cardiac event not significantly different (620 vs 606 days); cardiac mortality trend not significant (p=0.269); subgroup signal of reduced sudden cardiac death in patients with LVEF 25-35% | Conflicted |
| B | Exercise tolerance and quality of life in NYHA II-III heart failure (US population) | Zick 2009 HERB CHF trial (n=120, 900mg/day x 6 months): no significant improvement in 6-minute walk distance or Minnesota Living with Heart Failure quality-of-life score vs placebo; more adverse events in hawthorn arm | Conflicted |
| C | Mild hypertension (blood pressure reduction) | Walker 2002 pilot RCT (n=36 mildly hypertensive adults): non-significant diastolic trend (p=0.081) at 10 weeks; Walker 2006 RCT (n=79 type 2 diabetics on prescription drugs): significant diastolic reduction vs placebo (p=0.035), no effect on systolic BP | Early Signal |
| D | General 'heart health' / cardiovascular prevention in healthy adults | No RCTs of hawthorn in healthy adults for primary cardiovascular prevention; mechanistic and pre-clinical data only | Not There Yet |
| D | Anxiety and stress | Hanus 2004 RCT of a fixed combination (hawthorn + California poppy + magnesium) suggested anxiety reduction but the hawthorn-specific contribution is not isolable; no hawthorn-monotherapy RCT for anxiety | Not There Yet |
How to Choose: Forms, Doses & What Matters
Clinical dose: 900-1800mg/day of standardized WS 1442 extract (4-7:1, ethanolic extract standardized to oligomeric procyanidins) split twice daily. Most clinical trials used 900mg/day; the 1800mg/day arm of Tauchert 2002 produced the largest workload effect.
Best forms: WS 1442 standardized leaf-and-flower extract (Crataegutt by Dr. Willmar Schwabe, used in essentially all Cochrane-reviewed CHF trials), Standardized extracts to 1.8% vitexin-2-rhamnoside or 18.75% oligomeric procyanidins (the WS 1442 chemical markers), Solid extracts and tinctures from leaf and flower (traditional Western herbal preparation; not the trial-grade form), Whole-berry capsules (the most common US supplement format but the least studied; berries alone are lower in flavonoids than leaf-and-flower)
Most clinical trials used 900mg/day of WS 1442 (450mg twice daily) or 1800mg/day (900mg twice daily) for 6 months or longer. Effect on exercise tolerance and symptoms accumulates over weeks; trials typically read out at 12 to 24 weeks. Take with food to reduce mild GI upset. If using a non-WS-1442 product, look for standardization to either 1.8% vitexin-2-rhamnoside or 18.75% oligomeric procyanidins (OPCs) to approximate the trial-grade chemistry; whole-berry capsules without a flavonoid or procyanidin standardization are the least predictable form. Allow at least 6-8 weeks at a consistent dose before judging effect. Do not stop or adjust prescribed heart failure or blood pressure medications based on starting hawthorn.
Who Should Take Hawthorn Berry?
Adults with diagnosed chronic heart failure (NYHA class II-III) whose cardiologist is open to a standardized phytotherapeutic adjunct alongside guideline-directed therapy (ACE inhibitors or ARBs, beta-blockers, diuretics). The trial-grade form is WS 1442 at 900mg/day, escalating to 1800mg/day under supervision. Adults with mild, uncomplicated essential hypertension who want a low-evidence adjunct and have discussed it with their physician, particularly if they are already on prescription antihypertensives and want to coordinate monitoring. People interested in traditional Western herbal cardiovascular tonics who understand the evidence is strongest for the standardized extract, not the whole berry.
Who Should Avoid It?
Not for everyone
Side Effects & Safety
Product Scores
8 products scored on dosing accuracy, third-party testing, cost per effective dose, and label transparency.
The Scorecard: 8 Products Compared
Hawthorn Extract 300mg, 90ct
NOW Foods$8.99 ÷ 30 days at 900mg/day (3 servings × 300mg)
The best of the widely available US hawthorn products if you want something closer to the trial-grade chemistry than a whole-berry capsule. Vitexin-2-rhamnoside is the vitexin glycoside used as a WS 1442 quality marker, though this product is not branded as WS 1442.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Supreme Liquid Phyto-Caps
Gaia Herbs$25.99 ÷ 30 days at 2150mg/day (2 servings × 1075mg)
The pick for buyers who value traceability and the traditional whole-plant preparation over a specific WS 1442 chemical fingerprint. Gaia's Meet Your Herbs program is among the better transparency offerings in the US herbal market.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Berry Standardized Extract
Bluebonnet Nutrition
$17.99 ÷ 40 days at ~901mg/day (1.5 servings × 600mg)
Reasonable middle-ground SKU - standardized chemistry, but berry-based plant part means it is not a one-for-one substitute for WS 1442.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Liquid Extract (Berry & Flowering Top)
Herb Pharm
$22.95 ÷ 30 days at 0mL/day (1 serving × 0mL)
Strong pick for traditional Western herbal use of hawthorn. Not the trial-grade WS 1442 chemistry, but a high-quality, transparently produced tincture from a respected botanical brand.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Berries 510mg, 100ct
Nature's Way
$9.99 ÷ 100 days at 510mg/day (1 serving × 510mg)
The default US supplement-aisle hawthorn product. Reasonable for traditional Western herbal use, but a poor proxy for the trial-grade WS 1442 chemistry.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Solid Extract
Vitanica
$33.95 ÷ 60 days at 1000mg/day (1 serving × 1000mg)
The pick for someone working with a naturopath or clinical herbalist who specifically wants the solid-extract format. Not a substitute for WS 1442 in the clinical sense.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Berry Extract Vegetable Capsules
Solgar$16.99 ÷ 33 days at 1560mg/day (3 servings × 520mg)
Reasonable pick if you already trust the Solgar brand and want a flavonoid-standardized berry preparation. Not a closer match to the trial chemistry than the NOW SKU.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Hawthorn Berry Alcohol-Free Liquid
Nature's Answer
$14.99 ÷ 30 days at 0mL/day (1 serving × 0mL)
Niche pick if you need an alcohol-free hawthorn tincture. Furthest from the WS 1442 trial chemistry among the named-brand options here.
Prices checked 2026-05-15. Cost shown is per clinically effective daily dose, not per pill.
Full Comparison
| Category | Hawthorn Extract 300mg, 90ct NOW Foods | Hawthorn Supreme Liquid Phyto-Caps Gaia Herbs | Hawthorn Berry Standardized Extract Bluebonnet Nutrition | Hawthorn Liquid Extract (Berry & Flowering Top) Herb Pharm | Hawthorn Berries 510mg, 100ct Nature's Way | Hawthorn Solid Extract Vitanica | Hawthorn Berry Extract Vegetable Capsules Solgar | Hawthorn Berry Alcohol-Free Liquid Nature's Answer |
|---|---|---|---|---|---|---|---|---|
| Brand Score | 76/100Winner | 74/100 | 73/100 | 73/100 | 72/100 | 72/100 | 70/100 | 68/100 |
| Dosing & Form | 18/25Winner | 18/25 | 18/25 | 17/25 | 16/25 | 17/25 | 16/25 | 15/25 |
| Purity | 18/25 | 19/25Winner | 18/25 | 19/25 | 18/25 | 18/25 | 18/25 | 17/25 |
| Value | 21/25 | 14/25 | 18/25 | 15/25 | 22/25Winner | 14/25 | 17/25 | 18/25 |
| Transparency | 19/25 | 23/25Winner | 19/25 | 22/25 | 16/25 | 23/25 | 19/25 | 18/25 |
| Cost/Day | $0.30 | $0.87 | $0.45 | $0.77 | $0.10Winner | $0.57 | $0.51 | $0.50 |
| Dose/Serving | 300mg | 1075mg | 600mg | 0mL | 510mg | 1000mg | 520mg | 0mL |
| Form | Hawthorn leaf-and-flower extract, 1.8% vitexin-2-rhamnoside standardized (capsule) | Liquid extract of hawthorn leaf, flower, and berry (vegetarian phyto-cap) | Hawthorn berry extract, 1.8% vitexin (capsule) | Hawthorn berry and flowering top fluid extract (1:2) in organic cane alcohol and distilled water | Whole hawthorn berry (capsule) | Concentrated hawthorn berry solid extract (paste) | Hawthorn berry extract (1.8% flavonoids) plus raw berry powder (vegetable capsule) | Hawthorn berry Bio-Chelated liquid extract (alcohol-free, vegetable glycerin and water) |
| Third-Party Tested | No | ✓ Yes | No | ✓ Yes | No | No | No | No |
| Proprietary Blend | No | No | No | No | No | No | No | No |
Frequently Asked Questions
What is WS 1442 and why does it matter?
WS 1442 is a standardized extract of hawthorn leaf and flower (Crataegus monogyna or oxyacantha), manufactured by Dr. Willmar Schwabe Pharmaceuticals in Germany and sold there as the prescription-grade product Crataegutt. It is a 4-7:1 ethanolic extract standardized to 18.75% oligomeric procyanidins. Almost every clinical trial of hawthorn in heart failure - the Cochrane-reviewed studies, SPICE, Tauchert 1999 and 2002, HERB CHF - used WS 1442 or a closely matched extract. Most US supplement-aisle hawthorn products are whole-berry capsules or unstandardized leaf-and-flower extracts and have not been clinically tested in the same way. If you want the form with the data, look for products that explicitly name WS 1442 or provide a procyanidin or vitexin standardization that approximates it.
Can I take hawthorn with my blood pressure medication?
Talk to your prescriber first. Hawthorn has a mild blood pressure-lowering effect and can be additive with ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, and diuretics. The clinical risk is excessive blood pressure drop, especially on standing, which can cause dizziness and falls in older adults. None of this means hawthorn cannot be combined with antihypertensives - many of the heart failure trials did exactly that - but it does mean you should not start hawthorn without your prescriber's awareness so they can monitor blood pressure and adjust if needed.
Will hawthorn interact with digoxin?
The pharmacokinetic interaction looks small. Tankanow et al. 2003 dosed 8 healthy volunteers with both digoxin and hawthorn in a crossover design and found no significant change in digoxin's plasma pharmacokinetics. The pharmacodynamic concern is different: hawthorn has its own positive inotropic and mild bradycardic effects, which could theoretically be additive with digoxin's. The conservative position - and the one most cardiologists take - is that combining hawthorn with digoxin should be done only with cardiologist awareness and digoxin level monitoring, even though the small PK study was reassuring.
Does hawthorn work for general 'heart health' if I do not have heart failure?
There is no good evidence that it does. Every well-conducted hawthorn trial has been in chronic heart failure (NYHA II-III) or mild hypertension. There are no RCTs of hawthorn in healthy adults for primary cardiovascular prevention, lipid lowering, or coronary calcium progression. The marketing language on most US hawthorn supplements promises 'heart support' or 'cardiovascular wellness,' but those claims rest on extrapolation from heart-failure trials, not on data in healthy people. If you have no diagnosed cardiovascular condition, the case for hawthorn is weak.
How long until hawthorn works?
Heart failure trials read out at 12 to 24 weeks. SPICE ran for 24 months. The HERB CHF trial ran 6 months. Tauchert 2002 ran 16 weeks. Subjective symptom changes (fatigue, dyspnea on exertion) sometimes appear in the first 4-8 weeks of consistent dosing; objective exercise-test changes typically take longer. If you have not noticed anything in 8 weeks at 900mg/day of a standardized extract, the chance that more time will help is low.
Are the German trial results reliable, given that Schwabe makes WS 1442?
It is a real consideration. Most WS 1442 trials were either funded by Dr. Willmar Schwabe Pharmaceuticals or conducted at sites with industry ties, which is the same situation as with most other patented herbal extracts. The Pittler 2008 Cochrane review accounted for this in its risk-of-bias assessment and still concluded there was a significant benefit for symptoms and workload. The largest trial (SPICE, also Schwabe-funded) did not show a clear mortality benefit, which suggests publication bias is not driving a uniformly positive picture. The independent US HERB CHF trial (Zick 2009, NIH-funded) was negative, which adds a useful counterweight. Treat the evidence base as 'consistent but industry-leaning' rather than 'settled.'
Can hawthorn replace my heart failure medication?
No. Hawthorn was tested as an adjunct to standard heart failure therapy in every trial that found a benefit. None of the studies compared hawthorn against ACE inhibitors, beta-blockers, or diuretics as a substitute. Stopping prescribed heart failure medication and switching to hawthorn is a way to get hospitalized. If your cardiologist is willing to consider hawthorn alongside guideline-directed therapy, that is the only setting where the evidence applies.
Berry, leaf-and-flower, or whole plant - which form?
Leaf-and-flower extracts (the form used in WS 1442 and almost every clinical trial) contain higher concentrations of the active flavonoids and oligomeric procyanidins than berries alone. Whole-berry capsules are the most common US supplement format but the least studied. If a product is sold as 'hawthorn berry' without a leaf-and-flower component and without a procyanidin or vitexin standardization, you are getting a traditional preparation rather than the clinically tested form. That is not necessarily worthless - it is just not what the trials tested.
Sources
- Pittler MH, Guo R, Ernst E. Hawthorn extract for treating chronic heart failure. Cochrane Database Syst Rev. 2008;(1):CD005312.
- Holubarsch CJF, Colucci WS, Meinertz T, Gaus W, Tendera M. The efficacy and safety of Crataegus extract WS 1442 in patients with heart failure: the SPICE trial. Eur J Heart Fail. 2008;10(12):1255-1263.
- Tauchert M. Efficacy and safety of crataegus extract WS 1442 in comparison with placebo in patients with chronic stable New York Heart Association class-III heart failure. Am Heart J. 2002;143(5):910-915.
- Tauchert M, Gildor A, Lipinski J. High-dose Crataegus extract WS 1442 in the treatment of NYHA stage II heart failure. Herz. 1999;24(6):465-474.
- Zick SM, Vautaw BM, Gillespie B, Aaronson KD. Hawthorn Extract Randomized Blinded Chronic Heart Failure (HERB CHF) trial. Eur J Heart Fail. 2009;11(10):990-999.
- Walker AF, Marakis G, Morris AP, Robinson PA. Promising hypotensive effect of hawthorn extract: a randomized double-blind pilot study of mild, essential hypertension. Phytother Res. 2002;16(1):48-54.
- Walker AF, Marakis G, Simpson E, Hope JL, Robinson PA, Hassanein M, Simpson HCR. Hypotensive effects of hawthorn for patients with diabetes taking prescription drugs: a randomised controlled trial. Br J Gen Pract. 2006;56(527):437-443.
- Tankanow R, Tamer HR, Streetman DS, Smith SG, Welton JL, Annesley T, Aaronson KD, Bleske BE. Interaction study between digoxin and a preparation of hawthorn (Crataegus oxyacantha). J Clin Pharmacol. 2003;43(6):637-642.
- Pittler MH, Schmidt K, Ernst E. Hawthorn extract for treating chronic heart failure: meta-analysis of randomized trials. Am J Med. 2003;114(8):665-674.
FDA Disclaimer: These statements have not been evaluated by the Food and Drug Administration. The products discussed on this page are not intended to diagnose, treat, cure, or prevent any disease. Always consult with a qualified healthcare professional before starting any supplement regimen.