Stress, anxiety and high blood pressure tend to show up together, and they feed each other. A new randomized trial asked whether a standardized ashwagandha extract could help with the stress and anxiety side of that loop. The headline number is striking: serum cortisol fell by about 29% in the ashwagandha group. The details matter, though, so here is what the study found and what it can't tell us.
What the researchers tested
The paper, published in the journal Stress in 2026 (Pattojoshi et al.), tested Ashwagen, a standardized extract of Withania somnifera (ashwagandha). It was a randomized, double-blind, placebo-controlled Phase III trial with 60 patients diagnosed with stress, anxiety and pre-existing hypertension, all with cardiometabolic risk factors.
Participants took one 300 mg capsule twice daily (600 mg a day) for 60 days, either Ashwagen or a placebo. The team tracked:
- Anxiety and stress scales: HAM-A, GAD-7 and the Perceived Stress Scale (PSS)
- Global improvement, sleepiness and fatigue: CGI-I, Epworth Sleepiness Scale and Fatigue Severity Scale
- Biomarkers: serum cortisol, triglycerides, LDL cholesterol and blood pressure
The study was designed around people who have stress and anxiety on top of hypertension, a group often left out of supplement trials.
The numbers that grabbed attention
In the ashwagandha group, the reported reductions were:
- GAD-7 (anxiety): about 51% lower
- PSS (perceived stress): about 30% lower
- HAM-A (clinician-rated anxiety): about 27% lower
- Serum cortisol: about 29% lower
- Triglycerides: about 13% lower
The authors report that anxiety and stress measures improved significantly compared with placebo. Note that the percentages above are changes within the ashwagandha arm. The abstract doesn't give the placebo group's figures, so we can't say how much of each drop is the supplement and how much is the placebo response. In anxiety trials, the placebo response can be substantial.
Cortisol: the curiosity-gap number
Cortisol is the main output of the hypothalamic-pituitary-adrenal (HPA) axis, the body's stress-response system, and the authors frame the study around HPA activation. A roughly 29% drop alongside lower anxiety and stress scores is consistent with an adaptogen that calms that system.
Be careful with what that proves, though. Cortisol varies with time of day, sleep, and the stress of the blood draw itself. A lower reading in a single measure doesn't show better health outcomes. The study also can't say whether cortisol reduction caused the symptom improvements or just moved alongside them.
What about blood pressure and cholesterol?
This is where the headline needs tempering. The abstract describes only "favorable trends" in LDL cholesterol and blood pressure. That is not a clear, significant effect. Anyone hoping ashwagandha will replace their antihypertensive medication should read this as a no. The trial's conclusion calls it an adjunctive intervention for stress and anxiety in people with hypertension, not a blood pressure treatment.
Triglycerides did fall by about 13% in the ashwagandha group. It's a promising cardiometabolic signal, but it needs confirmation in larger, longer studies.
Safety findings
No serious adverse events were reported. For a 60-day trial this is reassuring, but 60 people is too few to detect rare problems.
Limitations to keep in mind
- Small sample: 60 participants limits precision and generalizability.
- Short duration: 60 days says nothing about long-term effects or whether benefits persist after stopping.
- Within-group percentages: the reported reductions don't show the size of the difference versus placebo.
- Sponsor links: several authors are affiliated with Dr. Willmar Schwabe India, a manufacturer of the extract, and others with a healthcare services company. That doesn't invalidate the results, but independent replication matters.
- Branded extract: results apply to this standardized Ashwagen product, not necessarily to any ashwagandha powder or capsule.
- Blood pressure: only trends, not a demonstrated effect.
Practical takeaways
Dose used in the trial: 300 mg of the standardized extract twice daily (600 mg/day) for 60 days. The abstract doesn't specify timing relative to meals, so follow the product label.
Who it might be relevant for: adults with stress and anxiety who also have hypertension, ideally under a clinician's supervision and in addition to their prescribed treatment. That is the population studied.
Who should skip it or ask a doctor first:
- Pregnant or breastfeeding women. Ashwagandha is generally advised against in pregnancy.
- People with thyroid conditions or on thyroid medication. Ashwagandha may affect thyroid hormone levels.
- People with liver disease or a history of liver problems. Rare cases of liver injury have been reported with ashwagandha products.
- Anyone on blood pressure medication. Possible interactions or additive effects mean your prescriber should know before you start.
- People taking sedatives or anti-anxiety drugs, because of possible additive effects.
Realistic expectations: treat this as one promising, sponsor-linked trial. It supports ashwagandha as a possible add-on for stress and anxiety in hypertensive patients. It does not establish it as a cure for either condition, and it should not replace medical care.
Bottom line
A 29% cortisol drop and a roughly 51% fall in GAD-7 scores make a compelling story, and the double-blind, placebo-controlled design lends it credibility. But the sample is small, the follow-up is short, the placebo numbers aren't in the abstract, and blood pressure improvements were only trends. Ashwagandha looks interesting for stressed people with high blood pressure. Larger, independent trials will show whether it lives up to the headline.
