The name "hawthorn" is derived from "hedgethorn," reflecting this spiny tree's use as a living fence in much of Europe. Besides protecting estates from trespassers, hawthorn has also been used medicinally since ancient times. Roman physicians used hawthorn as a heart drug in the first century AD, but most of the literature from that period focuses on its symbolic use for religious rites and political ceremonies.

During the Middle Ages, hawthorn was used for the treatment of dropsy, a condition we now call congestive heart failure. It was also used for treating other heart ailments as well as for sore throat.

Meaningful evidence indicates that hawthorn is a safe and effective treatment for congestive heart failure (CHF). Like other treatments used for CHF, hawthorn improves the heart's pumping ability. However, it may offer some important advantages over certain conventional drugs used for this condition.

Digoxin, as well as other medications that increase the power of the heart, also make the heart more susceptible to dangerous irregularities of rhythm (arrhythmias). In contrast, preliminary evidence indicates that hawthorn may have the unusual property of both strengthening the heart and stabilizing it against arrhythmias.1-3

It is thought to do so by lengthening what is called the refractory period. This term refers to the short period following a heartbeat during which the heart cannot beat again. Many irregularities of heart rhythm begin with an early beat. Digoxin shortens the refractory period, making such a premature beat more likely, while hawthorn protects against such potentially dangerous breaks in the heart's even rhythm.

Another advantage of hawthorn is its lower toxicity. With digoxin, the difference between the proper dosage and the toxic dosage is dangerously small. Hawthorn has an enormous range of safe dosing.4

However, keep in mind that digoxin is itself an outdated drug. There are a great many newer drugs for CHF (such as ACE inhibitors) that are much more effective than digoxin. Many of these have been proven to prolong life in people with advanced CHF. There is as yet no reliable evidence that hawthorn offers the same benefit (although one large study found tantalizing hints that it might).22One small study concluded that it may be safe to combine hawthorn and digoxin,23 but whether hawthorn interacts safely with other heart drugs remains to be determined.

Finally, CHF is simply too dangerous a condition to rely solely on self-treatment.

The bottom line: If you have CHF, do not use hawthorn except under close physician supervision.

The bottom line: If you have CHF, do not use hawthorn except under close physician supervision.

In addition to CHF, hawthorn is sometimes used as a treatment for annoying heart palpitations that have been thoroughly evaluated and found to be harmless. Common symptoms include occasional thumping as well as episodes of racing heartbeat. These may occur without any identifiable cause and may not require any medical treatment, except for purposes of comfort. However, there is no evidence that hawthorn is effective for this purpose. Furthermore, because there are many dangerous kinds of heart palpitations, it is absolutely necessary to get a thorough checkup first. It is only worth considering hawthorn as a treatment for palpitations if a doctor tells you that you have no medically significant heart problems.

Hawthorn is sometimes recommended for the treatment of high blood pressure, but its effects appear to be marginal at best.5,6,13,20Furthermore, there is some evidence that a combination herbal treatment made from hawthorn and camphor can help prevent the sudden fall in blood pressure that may occur on standing up from a sitting or lying position (orthosatic hypotension).16,17 In these studies, the mixture acted to increase blood pressure.

Hawthorn has also been tried for other heart-related conditions, such as angina and atherosclerosis in general, but there is no reliable evidence to support these uses.