Ashwagandha for Anxious, Hypertensive Patients

Ashwagandha cut cortisol, anxiety, and triglycerides in patients who had all three problems at once

STUDY: Pattojoshi A et al, Stress 2026;29(1)

STUDY TYPE: Randomized, double-blind, placebo-controlled trial

FUNDING: Independent

Background

Stress, anxiety, and hypertension form a well-known vicious cycle: chronic psychological stress drives cortisol and sympathetic tone up, which raises blood pressure and worsens lipid profiles. Ashwagandha (Withania somnifera) is an adaptogenic herb that modulates stress hormones (HPA axis) and has shown anxiolytic effects in healthy adults.

This study tested whether it works in patients who already have hypertension and cardiometabolic risk factors.

The Study

• 60 adults with anxiety, stress, and pre-existing hypertension in India
• Randomized to ashwagandha 300 mg twice daily or placebo for 60 days
• Double-blind

Anxiety scores improved on ashwagandha across all three measures. The Anxiety scale (HAM-A) fell 27% in the ashwagandha group versus 15% with placebo. The Anxiety scale (GAD-7) dropped 51% versus 23%. The Perceived Stress Scale (PSS) fell 30% versus 12%.

Cortisol dropped 29% with ashwagandha versus 7% with placebo. Triglycerides fell 13% versus a slight increase in the placebo group. Systolic blood pressure dropped about 11 mmHg with ashwagandha while it rose slightly with placebo, though the ashwagandha group started with higher baseline blood pressure, so this difference is hard to interpret cleanly. Fatigue, daytime sleepiness, and global clinical impression also improved more on ashwagandha.

Side Effects

No serious adverse events. All side effects were mild to moderate and resolved without stopping treatment.

Limitations

Very small sample (30 per arm), single center, no formal power calculation, and baseline imbalances in sex distribution and blood pressure between groups. The product was supplied by the manufacturer.

Practice Implications

1. Though small, the study adds to a larger evidence base for ashwagandha in stress-related conditions.
2. Psychotherapy is first-line for stress. When it comes to medications for stress, we only have benzodiazepines, and alternatives to those are needed.
3. Some ashwagandha products have had contamination problems, and it is associated with rare liver risks, so make sure to use lab-tested products if recommending it.