Nesiritide, the commercially available form of B-type natriuretic hormone, improved the overall clinical status of patients with acutely decompensated congestive heart failure and several indicators of cardiovascular function in randomized trials. In a trial comparing it to a variety of other agents, efficacy was similar, but fewer patients receiving nesiritide required intravenous diuretics. Nesiritide was associated with significantly lower 6-month mortality than dobutamine, which was found to be more proarrhythmic in an open-label trial. Nesiritide also caused a faster and greater improvement in pulmonary capillary wedge pressure than intravenous nitroglycerin. Adverse effects for nesiritide are generally lower than for other vasoactive agents used for heart failure. The primary adverse effect, hypotension, is dose related and causes symptoms in only about 4% of patients at the current recommended dose. Other side effects are minor or occur infrequently.