Arjuna

What arjuna is

Arjuna is the dried stem bark of Terminalia arjuna, a tree from India. It is used as a powder or as an extract. According to Bharani 2002, a bark extract used in studies contains, among other things, arjunic acid and terminic acid, glycosides such as arjunetin and arjunosides I to IV, plus flavones, tannins and oligomeric proanthocyanidins.

In the BK-Score, human evidence stands at 5 out of 10 points. This axis rates the state of knowledge, not the substance: there are several randomized trials, but they are small, short and almost all from India. The heart strengthening with which arjuna is marketed has not been shown on the hardest outcome measure.

How it works

The antioxidant constituents of the bark are held responsible for the effect on the heart. In humans, this has only been measured via surrogate markers: in the study by Gupta 2001, lipid peroxides in the blood fell by 29.3 percent after 30 days of bark powder, and by 36.4 percent under vitamin E. In the heart failure study by Maulik 2016, the activity of the protective enzyme catalase in red blood cells was better preserved under arjuna than under placebo.

A plausible mechanism is not yet a clinical benefit. Which constituent in what amount is supposed to trigger the observed effects on angina or blood pressure has not been clarified in humans.

What the studies show

Heart failure: the 2026 meta-analysis and the largest single trial

Kumar 2026 pooled 9 randomized trials with 537 patients. Left ventricular mass fell markedly; ejection fraction rose by 1.85 percentage points, which missed significance (p = 0.1). Blood pressure, triglycerides and LDL did not change. The largest single trial, Maulik 2016, gave 100 patients with NYHA class II heart failure and an ejection fraction of at most 40 percent arjuna extract or placebo for 12 weeks in addition to standard therapy, double-blind. Ejection fraction as the primary endpoint remained unchanged (24.3 versus 25.5 percent), as did walking distance, quality of life, BNP and inflammatory markers. Better values appeared only in post hoc subgroup analyses.

Stable angina: Bharani 2002

In a double-blind crossover trial, 58 men with stable angina and exercise-induced ischemia each received arjuna extract, isosorbide mononitrate or placebo for one week. Under arjuna they needed less nitrate spray (5.69 versus 18.22 mg per week), exercise duration rose from 4.76 to 6.14 minutes, and ST depression in the exercise ECG decreased. There was no significant difference between arjuna and the nitrate. Women were not studied.

Severe heart failure: Bharani 1995

Twelve patients with treatment-resistant NYHA class IV heart failure received arjuna or placebo for two weeks each in a double-blind crossover, in addition to standard therapy. Under arjuna, ejection fraction was 35.3 instead of 30.2 percent, and heart volumes were smaller. The subsequent long-term follow-up over about two years was open-label, without a comparison group.

Blood pressure and blood lipids: Nazir 2026 and Gupta 2001

Nazir 2026 assigned 44 people with stage 1 hypertension to arjuna or placebo; all also took telmisartan. After 28 days, blood pressure fell in both groups, more so under arjuna; cholesterol and triglycerides also declined. The trial was triple-blind and registered. Gupta 2001 compared placebo, vitamin E and arjuna powder over 30 days in 105 patients with coronary heart disease. In the arjuna group, total cholesterol fell by 9.7 percent and LDL by 15.8 percent from baseline; a direct statistical comparison with placebo is not reported in the abstract.

Where the data stop

• Better pump function in heart failure. The largest placebo-controlled trial found no effect on ejection fraction, and in the meta-analysis it missed significance. The positive data from Bharani 1995 come from 12 patients.
• Hard endpoints. None of the studies evaluated here examined heart attacks, hospital admissions or deaths as an outcome.
• Transferability. Almost all studies come from India, are small and short, some with one-week treatment phases. The angina trial included only men.
• Comparability of products. Bark powder, extracts and aqueous extracts were tested in different amounts. Results for one extract cannot simply be transferred to another product.

Status, approval and legal

In Germany, arjuna is sold as a food supplement. There are no authorized health claims for it: the EU list under Regulation 432/2012 contains no claim on arjuna or Terminalia.

In 2020, the Joint Expert Commission of BVL and BfArM stated that products of the Ayurvedic tradition can be foods or medicines depending on their ingredients, dosage, pharmacological action and presentation, that for foods it must be checked whether they are novel foods, and that in general they must be assessed case by case. The statement does not contain a specific classification of arjuna.

Safety

In the studies, no relevant side effects were reported over periods from days up to 12 weeks. Long-term data are lacking, as are data on pregnancy, breastfeeding and children. In the BK-Score, safety stands at 3 out of 10 points; this axis measures how well safety has been studied, not how safe the substance is.

Product quality is a separate issue. According to the BVL and BfArM expert commission, the quality of Ayurvedic products is very heterogeneous; experts from official food control found very high levels of lead, mercury and arsenic in individual imported Ayurvedic food supplements. Because the studies almost always tested arjuna in addition to heart medication without systematically examining interactions, taking it with heart disease should be coordinated with a physician. This text is information and does not replace medical advice.

Sources

• Kumar A et al., Ann Afr Med 2026 – meta-analysis, 9 randomized trials, 537 patients with heart failure
• Maulik SK et al., Phytomedicine 2016 – double-blind trial, 100 patients with chronic heart failure over 12 weeks
• Bharani A et al., Indian Heart J 2002 – double-blind crossover trial, 58 men with stable angina, comparison with isosorbide mononitrate
• Bharani A et al., Int J Cardiol 1995 – double-blind crossover trial, 12 patients with severe heart failure
• Gupta R et al., J Assoc Physicians India 2001 – randomized trial, 105 patients with coronary heart disease, blood lipids and lipid peroxides
• Nazir A et al., Explore (NY) 2026 – triple-blind trial, 44 people with stage 1 hypertension
• Joint Expert Commission BVL/BfArM 2020 – statement on the classification of products of the Ayurvedic tradition (01/2020)
• Regulation (EU) No 432/2012 – list of permitted health claims made on foods