Hawthorn (Crataegus monogyna / laevigata)

Hawthorn is a herbal product with EMA HMPC traditional use for mild chronic heart failure symptoms (NYHA I–II) in patients in whom severe pathology has been excluded. The Cochrane 2008 review reported moderate improvement in exercise tolerance and dyspnoea. The large SPICE trial (Holubarsch 2008, n = 2681, NYHA II–III) gave the headline result: WS 1442 does not reduce cardiovascular mortality on top of standard therapy. The ESC HF 2021 guideline does not include hawthorn in the chronic heart failure treatment algorithm. Hawthorn does not replace ACE inhibitors, beta-blockers, mineralocorticoid antagonists or SGLT2 inhibitors. If hawthorn was offered as a substitute for standard therapy, consider seeking a second opinion from a cardiologist.

Hawthorn is popular in Spain and Russia as a «mild remedy for blood pressure». The small Walker 2006 trial in patients with type 2 diabetes and hypertension reported a minor diastolic BP reduction of about 3 mmHg with 1000 mg/day extract over 16 weeks – clinically marginal. No systematic review confirms an antihypertensive effect. ESC/ESH 2024 and SEH-LELHA 2022 guidelines do not include hawthorn in initial or maintenance hypertension therapy. Substituting hawthorn for ACE inhibitors, ARBs, thiazide diuretics or calcium channel blockers is not justified. If BP remains uncontrolled, discuss standard pharmacotherapy with a general practitioner or cardiologist.

Hawthorn tincture sits under EMA HMPC as traditional use for mild nervous tension and sleep disturbances, usually in combinations with valerian, passionflower and lemon balm. No quality RCTs of hawthorn alone in anxiety disorders exist; the perceived effect mostly reflects the ritual of taking the product and the herbal combination. AEMPS registers these combinations as traditional herbal medicines – a status, not evidence of efficacy by modern standards. For pronounced or persistent anxiety, the evidence supports psychotherapy and, when indicated, physician-prescribed SSRIs or SNRIs. If hawthorn was offered as a substitute for anxiety treatment, consider seeking a second opinion from a psychiatrist or psychotherapist.