Adaptogen cortisol: Pattojoshi et al., 2026
A 12-week RCT of 102 adults with diagnosed anxiety disorders and stage I hypertension found that 300 mg twice-daily ashwagandha extract reduced perceived stress by 38%, anxiety scores by 42%, and systolic blood pressure by 6.2 mmHg compared to placebo, with cortisol dropping 23%, mechanistically plausible but limited by a single proprietary extract and no comparison to first-line therapy.
Key takeaways
- Ashwagandha 600 mg daily for 12 weeks reduced cortisol 23%, perceived stress scale scores 38%, and systolic blood pressure 6.2 mmHg vs. placebo in adults with diagnosed anxiety and stage I hypertension
- This is a double-blind RCT with 102 participants, solid study design, but the sample is modest and dropout rate was 14%, right at the edge of acceptable
- The proprietary extract (Ashwagen®, 10% withanolides) makes direct comparison to other ashwagandha products difficult, standardization matters, but brand-specific results don't always generalize
- The study captured both surrogate endpoints (cortisol, blood pressure) and patient-reported outcomes (stress, anxiety scores), more convincing than cortisol alone
- No adverse cardiovascular events reported, but 12 weeks isn't long enough to establish cardiovascular safety in hypertensive populations
The study
Pattojoshi et al. published this randomized, double-blind, placebo-controlled trial in Stress in 2026 (PubMed). They enrolled 102 adults aged 30-65 with diagnosed generalized anxiety disorder or adjustment disorder and stage I hypertension (systolic 130-139 mmHg or diastolic 80-89 mmHg). Participants were randomized 1:1 to 300 mg Ashwagen® (a root extract standardized to 10% withanolides) twice daily or matched placebo for 12 weeks. Primary outcomes were changes in Perceived Stress Scale (PSS-10), Hamilton Anxiety Rating Scale (HAM-A), serum cortisol, and blood pressure. Secondary measures included fasting glucose, lipid panel, and high-sensitivity C-reactive protein. Fourteen participants dropped out (7 per arm), leaving 88 completers analyzed per-protocol.
How to read this study
What this paper does well: The design is genuinely double-blind and placebo-controlled, both groups got identical capsules. The 12-week duration is long enough to see cortisol axis adaptation, not just acute suppression. They measured both biological markers (cortisol, blood pressure) and validated patient-reported outcomes (PSS-10, HAM-A), which is stronger than relying on a surrogate alone. The participant population, diagnosed anxiety with comorbid hypertension, is clinically meaningful, not just "stressed college students." The statistical analysis was intent-to-treat for safety and per-protocol for efficacy, which is transparent.
What this paper is missing: The sample size is 102 enrolled, 88 completers, adequate for detecting the effect they found, but not powered to detect rare adverse events or subgroup effects. Dropout was 14%, right at the threshold where you start worrying about differential attrition biasing results. The extract is proprietary (Ashwagen®, not specified whether it's KSM-66, Sensoril, or another common standardization), so the findings don't automatically transfer to other ashwagandha products. The paper doesn't report who funded it until the disclosures, two authors are affiliated with the extract manufacturer, a red flag for bias. No comparison to first-line anxiety treatment (SSRIs, CBT) or antihypertensives, so we don't know if this effect is additive, synergistic, or redundant.
How I weight this paper: This is the strongest-designed ashwagandha-cortisol trial I've seen in a hypertensive population, and I weight it accordingly, it moves my prior. The combination of subjective improvement (stress, anxiety) with objective markers (cortisol, blood pressure) is more convincing than either alone. But I don't treat it as dispositive. The proprietary extract and industry ties mean I want replication by an independent group. If you're managing clinical anxiety or hypertension, this isn't a substitute for medical treatment, it's a potential adjunct worth discussing with your physician.
What they found
At 12 weeks, the ashwagandha group showed a mean reduction in serum cortisol of 5.8 μg/dL (23% decrease) compared to 0.9 μg/dL in placebo (p < 0.001). PSS-10 scores dropped 9.2 points (38% reduction) in the treatment group vs. 2.1 points in placebo (p < 0.001). HAM-A anxiety scores declined 11.4 points (42% reduction) vs. 3.2 points in placebo (p < 0.001). Systolic blood pressure decreased 6.2 mmHg in the ashwagandha arm vs. 1.1 mmHg in placebo (p = 0.003); diastolic dropped 3.8 mmHg vs. 0.6 mmHg (p = 0.012). Fasting glucose showed no significant between-group difference. LDL cholesterol decreased 8.1 mg/dL in the treatment group (p = 0.04 vs. placebo). High-sensitivity CRP declined 0.7 mg/L in ashwagandha vs. 0.1 mg/L in placebo (p = 0.09, not statistically significant). Adverse events were mild, four cases of gastrointestinal upset in ashwagandha vs. two in placebo, no cardiovascular events, no hepatotoxicity on liver function tests.
What it means for the average man
If you have clinically significant stress or anxiety, not just "busy week" stress, but diagnosed disorder or symptoms severe enough to affect function, and you also have borderline-high blood pressure, ashwagandha at 600 mg daily may reduce both. The 6 mmHg systolic drop is about half what you'd get from first-line blood pressure medication, but it's not trivial. The cortisol reduction is substantial and lines up with the subjective stress improvement, which suggests the mechanism is real. The 12-week timeframe matters, this isn't a one-dose-before-a-presentation intervention. You need consistent use. The catch: this was a specific extract standardized to 10% withanolides. Generic ashwagandha powder or unstandardized capsules may not deliver the same dose. If you're on antihypertensives or anxiolytics, this isn't a replacement, talk to your physician before adding it, especially given the blood pressure effect.
The caveats
Two authors are affiliated with the extract manufacturer, and the funding source isn't disclosed until the acknowledgments section, classic setup for positive publication bias. The study population was Indian adults; we don't have data on whether the effect size holds across ethnicities or in populations with different baseline cortisol profiles. The 14% dropout rate is borderline high, if more people dropped out of one arm due to side effects, the per-protocol analysis could overestimate benefit. The proprietary extract limits generalizability. No long-term safety data beyond 12 weeks in hypertensive populations. The lack of active comparator (e.g., low-dose SSRI, low-dose ACE inhibitor) means we can't say whether ashwagandha is better, worse, or equivalent to standard care. The CRP reduction trended positive but didn't reach significance, inflammation reduction is suggested but not proven.
Frequently asked questions
Does industry funding mean this study is wrong?
Not automatically, but it's a red flag. Industry-funded studies are 4-5 times more likely to report positive results than independent trials. That doesn't mean the data are fabricated, it means selective outcome reporting, favorable design choices, and publication bias are more likely. In this case, the design is solid (double-blind RCT), so I don't dismiss it. But I weight it less than I would an NIH-funded replication by an unaffiliated team.
Is 102 participants enough to trust the results?
For the primary outcomes (stress scores, cortisol, blood pressure), yes, the effect sizes were large enough that 102 participants gave adequate statistical power. For rare adverse events, no, you'd need hundreds or thousands of participants to detect a 1-in-500 liver injury or cardiac event. The study wasn't designed to rule out rare harms, only to detect common benefits.
Will any ashwagandha product give me these results?
Unlikely. The study used a proprietary extract standardized to 10% withanolides. Ashwagandha root powder, different extracts (KSM-66 is typically 5% withanolides, Sensoril is 10% but a different ratio of withanolides to oligosaccharides), and unstandardized products may not deliver equivalent doses of active compounds. Standardization matters in botanical research.
Can I use ashwagandha instead of blood pressure medication?
No. The 6 mmHg systolic reduction is modest, useful as an adjunct, not a replacement for antihypertensives in someone with diagnosed hypertension. If you're on medication, talk to your physician before adding ashwagandha, because the blood pressure effect could be additive and cause hypotension. If you're not on medication but have stage I hypertension, lifestyle modification (sodium reduction, weight loss, exercise) is first-line, not supplements.
Sources
- Pattojoshi A, Kumar Patra S, Idrees S, et al. Safety and efficacy of ashwagen (a standardized withania somnifera extract) in stress and anxiety with hypertension and associated cardiometabolic risk factors: a randomized, placebo-controlled trial. Stress. 2026. PubMed
- Lopresti AL, Smith SJ, Malvi H, Kodgule R. An investigation into the stress-relieving and pharmacological actions of an ashwagandha (Withania somnifera) extract: A randomized, double-blind, placebo-controlled study. Medicine (Baltimore). 2019;98(37):e17186.
- Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med. 2012;34(3):255-262.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. The information provided in this article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician before starting any supplement, especially if you have a medical condition or take prescription medications.
