Nesiritide is the generic name for recombinant human B-type natriuretic peptide. This drug represents the first of a new class of agents for the treatment of decompensated congestive heart failure. The properties of B-type natriuretic peptide include a balanced arterial and venous vasodilatation and a marked natriuresis and diuresis, making it an excellent drug for the management of heart failure. We review the physiology and pathophysiology of the natriuretic peptides and the clinical data for nesiritide. In addition, the hemodynamic effects of the drug as well as its efficacy and safety in the treatment of heart failure are critiqued. Nesiritide is a new class of therapeutic peptide for the treatment of heart failure that appears to offer unique and safe hemodynamic properties.