A long-used European heart remedy. Standardized leaf-and-flower extracts improve exercise capacity and symptoms in mildly declining heart pump function, with a small drop in blood pressure and modest, less certain gains in blood fats. The two largest trials missed their main goals, and one re-analysis raised a signal of early worsening where pumping function is already substantially reduced. (Full Review)
| Marker | Target | Why |
|---|---|---|
| Home blood pressure | Below 120/75 mmHg | Captures both the intended reduction and excessive additive drops |
| Resting heart rate | 50–70 bpm | Hawthorn modestly slows rate; a fall below 50 bpm signals additive effect with rate-slowing drugs |
| NT-proBNP | Below 125 pg/mL | Objective tracker of the early heart-failure progression signal |
| Left ventricular ejection fraction | Above 50%; 25–50% requires caution | Determines whether someone sits in the benefit subgroup or the harm subgroup |
| LDL cholesterol | 70–100 mg/dL depending on overall risk | Tracks the lipid claim, where hawthorn performs worst relative to conventional drugs |
| Triglycerides | Below 100 mg/dL | The lipid fraction most consistently moved in hawthorn trials |
| hs-CRP | Below 1.0 mg/L | Proxy for the vascular inflammation signal seen with hawthorn |
| Serum digoxin (trough) | 0.5–0.9 ng/mL | Guards the one interaction with a plausible mechanism |
| QTc interval | Below 440 ms in men, below 460 ms in women | Baseline rhythm reference when other rhythm-affecting drugs are used |
| eGFR | Above 90 mL/min/1.73 m² | Kidney function governs the safety of the diuretics hawthorn is stacked onto |
| 6-minute walk distance | No established target; track change from personal baseline, with 30 metres a meaningful shift | The functional endpoint the pivotal trials used |
Cadence: Home blood pressure and resting heart rate at 2 and 6 weeks; lipid panel, inflammation marker and walk distance at 12 weeks; review every 6 to 12 months. Digoxin level repeated at 4 weeks where co-prescribed.