BNP and nesiritide dosage and evidence
Written by Aaron CuhaReviewed Sep 2026
The short answer
BNP is a heart hormone with two lives. As a blood test, it is the standard way to check for heart failure. As a drug, it failed. In a study of 7,141 people, the drug version, nesiritide, barely helped breathing and did not change deaths or return trips to hospital. The product is now listed as discontinued.
Evidence grade for BNP and nesiritide: Strong. The rule: at least two finished studies in people, and at least 1,000 people who took it. The sum on this page: 3 completed trials, 7,149 people given it. A grade counts how much has been done to people, not whether it works.
- People given it
- 7,149
- Human studies
- 3
- Found nothing
- 1
Dose
No human dose established
Amounts that were given in studies sit in Human evidence on this page. None of them is a personal dose.
3 completed trials, 7,149 people given it
4 effects reported, 2 unwanted, 2 wanted, by people using it, not a trial
Goal pages: Ageing and longevity, Heart and circulation
In plain English
In plain English, from Aaron
This is how I would explain it to a friend. The evidence, with the numbers, is further down the page.
BNP is a hormone your heart makes when it is under strain. Doctors measure it with a blood test to check for heart failure. A lab-made version, nesiritide, was sold as a drug. It did not help, and it is now discontinued.
What people take it for
- Doctors use the blood test to spot heart failure.
- The drug was once used in hospital for sudden heart failure.
What studies in people showed
The big study settled it. 7,141 people in hospital with heart failure got nesiritide or a dummy drip. Breathing got only a little better, not enough to count. Death or return to hospital in 30 days was 9.4 percent on the drug and 10.1 percent on the dummy drip. That gap could be chance. Kidneys were no worse, but low blood pressure was more common. Earlier small studies had warned of kidney harm and more deaths. The big study did not confirm either.
What people report
Reports, not study results
The good
- Breathing got a little better on the drug, but not enough to count.
- The blood test picks out people at higher risk, whatever they weigh.
The bad
- Low blood pressure was more common on the drug.
- It did not cut deaths or return trips to hospital.
Where these come from: No user reports. These come from the ASCEND-HF study of 7,141 people and the smaller studies on this page.
My bottom line
The blood test is useful. The drug was not. If you have heart symptoms, ask for the test.
An opinion, not a finding. I am a coach, not a doctor.
What it has been measured to do
Measured in people
Goals BNP and nesiritide has been tested for in people, biggest studies first. We count only what the studies on this page say, so the real numbers may be higher.
- Kidney function7,146 people · 2 studies · 1 found nothing
- Heart attacks and strokes7,141 people · 1 study
- Living longer686 people · 1 study
33 of the 36 indexed goals have no study of any kind behind BNP and nesiritide
No study in people, animals or cells on this page reports a result for these. That does not prove BNP and nesiritide does nothing for them. It does mean anything you have heard about BNP and nesiritide and one of these did not come from a study cited here.
Show full evidence
What is BNP and nesiritide?
BNP is a heart hormone with two lives. As a blood test, it is the standard way to check for heart failure. As a drug, it failed. In a study of 7,141 people, the drug version, nesiritide, barely helped breathing and did not change deaths or return trips to hospital. The product is now listed as discontinued.
B-type natriuretic peptide, or BNP, is a hormone 32 building blocks long. The heart's main pumping chambers release it when their walls are under strain. Most people meet it in two ways, and the two get mixed up. So here is the difference first. As a blood test, doctors measure BNP, or its inactive piece NT-proBNP, to spot heart failure and judge how bad it is. That use is routine and well backed. As a drug, lab-made BNP is called nesiritide, sold as Natrecor. That is a different story.
Nesiritide was approved in 2001 because it eased breathlessness and improved pressure readings in the heart. The biggest study came later. The maker paid for a study large enough to settle the question. ASCEND-HF gave 7,141 people in hospital with sudden heart failure either nesiritide or a dummy drip, on top of their normal care. Breathing got a little better on nesiritide at 6 hours (44.5 against 42.1 percent) and at 24 hours (68.2 against 66.1 percent). Neither gap was big enough to count by the study's own rules. Return to hospital for heart failure or death within 30 days was 9.4 percent on the drug and 10.1 percent on the dummy drip. That is a gap of 0.7 points, small enough to be chance. Kidney function did not get worse, which cleared the drug of an earlier charge. But low blood pressure was more common. The authors wrote that nesiritide cannot be recommended for routine use. The maker, Scios, paid for the study.
Two smaller reviews in 2005 had raised the alarm before that. One pooled 5 small studies and found kidney function got worse more often, 1.52 times the risk. The other pooled 3 studies and found more deaths within 30 days (7.2 percent against 4.0 percent), a gap that fell just short of being clear.
We re-checked the US drug records on 11 September 2026. NATRECOR, application NDA 020920, from Scios LLC, is listed as discontinued. The record includes the government's finding that it was not pulled for safety or effectiveness reasons. No other nesiritide product is listed. The FDA label database returned no current Natrecor label.
How does BNP and nesiritide work?
In people, BNP docks on NPR-A, the same receptor ANP uses. That raises a messenger called cyclic GMP. The result is wider blood vessels, more salt leaving through the kidneys, and lower renin and aldosterone, two salt-holding hormones. That biology is what made a lab-made version look promising for sudden heart failure. The blood test rests on something else. When the heart's pumping chambers stretch, they make more of a parent protein called proBNP. That splits into active BNP and the inactive piece NT-proBNP. The level of either in the blood tracks how much strain the heart is under.
What have studies in people found about BNP and nesiritide?
The record is unusually complete, and mostly negative. There is one study of 7,141 people comparing the drug with a dummy drip. Before it came two reviews that raised safety worries. After it came deeper looks at the same data. Separately, BNP and NT-proBNP have a huge human record as blood tests that spot heart failure and predict how people will do.
- ASCEND-HF (2011): 7,141 people. Both main goals, breathlessness and death or return to hospital at 30 days, came out about even. Deaths from any cause at 30 days were 3.6 percent on nesiritide and 4.0 percent on the dummy drip. Low blood pressure was more common on nesiritide. The maker paid.
- Review of 5 small studies (2005): kidney function got worse more often, 1.52 times the risk. ASCEND-HF did not confirm this in 7,141 people. It is a case of one large study overturning a pool of small ones.
- Review of 3 small studies (2005): deaths at 30 days were 7.2 percent against 4.0 percent, 1.74 times the risk. The gap fell just short of being clear.
- A deeper look at the kidney data from ASCEND-HF, and the editorial that ran with it, closed the case that the drug protects the heart and kidneys together.
- As a blood test rather than a drug, NT-proBNP was measured in the ASCEND-HF patients. It tracks illness and death, with body weight shifting the readings.
What this does not tell you: ASCEND-HF tested one drug at one dose range, in people in hospital with sudden heart failure. It says nothing about this hormone system as a drug target in general. Neither the study nor the later looks can tell apart a drug that does nothing from a drug whose small benefit is cancelled out by low blood pressure. The blood test data come from watching people, by their nature. A high BNP tells you who is at risk. It does not tell you what to do about it.
The state of the research
This page exists because the story itself is the lesson. A hormone with perfect-looking biology was approved in 2001 because it helped symptoms and pressure readings. It sold widely. Two 2005 reviews of small studies questioned it. It was then tested properly in 7,141 people, at the maker's expense. It did not help, and it was finally discontinued. The FDA record still carries the government's finding that it was not pulled for safety or effectiveness reasons. That is a statement about the terms of withdrawal, not a verdict on ASCEND-HF.
Two things are worth taking away. First, a company paying for the study that sank its own product is exactly how this is supposed to work. That deserves saying plainly, in a field where company funding is usually only mentioned as a criticism. Second, the same molecule is still hugely useful in the form nobody sells as a peptide: the BNP and NT-proBNP blood tests. The research file behind this page could not find the main ASCEND-HF results paper and asked for it to be found before citing. It is PMID 21732835, New England Journal of Medicine, 7 July 2011, and that fix is recorded here.
The evidence, in charts
Fig. 1a · how many people
7,835people, across 4 studies in people cited here
| Study | People | Share |
|---|---|---|
| ASCEND-HF, New England Journal of Medicine 2011 | 7,141 | 91% |
| Journal of the American Heart Association 2018 | 686 | 9% |
| Circulation 2005 | 5 | 0% |
| JAMA 2005 | 3 | 0% |
One study holds 91% of these people, so the total rests more on one study than its size suggests. Counts are the number of people each study on this page says it signed up. That includes studies that only watched people and gave nobody the compound. 2 more studies in people give no headcount and are not counted here. Studies still signing people up are left out, and only studies cited on this page are counted.
Fig. 1b · evidence mix
6 of 7 sources here are studies in people. The rest is not.
- Study in people · done in people686%
- Review of studies · sums up other studies114%
Counted from the list of sources on this page. It counts only what we cite, so there may be more studies out there. A review counts once, however many studies it sums up.
Fig. 2 · evidence over time
The studies cover 5 different years, 2005 to 2018, counted from the list of sources on this page. The newest source on file is from 2018, more than five years ago. Research on it may have gone quiet.
Fig. 3 · legal status at a glance
US
Approved
UK
Not approved
AU
Not approved
CA
Not approved
Approved in 1 of 4, by prescription in 0, not approved in 3. This is what the law says, not a verdict on the science. See Legal status below for the full text and any notes.
Fig. 4 · how much does what
Nobody has tested different amounts in people
This chart would show how the effect changes as the amount goes up. For this compound, nobody has measured that in people. So we leave it empty. We will not borrow an animal chart and pretend it works the same in people.
Fig. 5 · what the molecule is
- Kind of compound
- Peptide
- Molecule weight
- Not on file
- Half-life
- None on file
- Chain length
- 32 amino acidscounted from the chain below
SPKMVQGSGCFGRKMDRISSSSGLGCKVLRRH
- Water-shy 14
- Water-loving 9
- Acidic 1
- Basic 8
One square per amino acid, left to right from the start of the chain, coloured by type. The type is a fact about the amino acid, not a finding about this compound.
The studies we cite
- Study in people2011Effect of nesiritide in patients with acute decompensated heart failure
This is the study that settled it, and the drug failed. 7,141 people in hospital with heart failure got nesiritide or a dummy drip on top of usual care. Breathlessness improved a shade more on the drug, not enough to count. Death or return to hospital within 30 days came out the same. Kidneys were no worse, but low blood pressure was more common. The maker paid for the study that ended its own product. A study this size would have found a real benefit.
ASCEND-HF: 7,141 people hospitalised with acute heart failure randomised to nesiritide or placebo for 24 to 168 hours on top of standard care. Dyspnoea improvement 44.5 versus 42.1 percent at 6 hours and 68.2 versus 66.1 percent at 24 hours, neither meeting the prespecified threshold. Rehospitalisation or death within 30 days 9.4 versus 10.1 percent (difference -0.7 percentage points, 95 percent confidence interval -2.1 to 0.7). No excess worsening renal function; more hypotension. Funded by Scios, the manufacturer.
- Study in people2005Short-term risk of death after treatment with nesiritide for decompensated heart failure: a pooled analysis of randomized controlled trials
Six years before the big study, pooled small studies raised a worry that this drug was killing people. Three trials were combined, with 485 patients on nesiritide and 377 on other treatment. Within 30 days, 7.2 percent on the drug had died against 4.0 percent on the comparison. The gap was not big enough to be sure of. The authors asked for a properly sized study before the drug stayed in use. That study was run, and it did not confirm a death signal.
Pooled analysis of 3 randomised trials, 485 patients on nesiritide and 377 on control. Death within 30 days occurred in 7.2 percent versus 4.0 percent, risk ratio 1.74, 95 percent confidence interval 0.97 to 3.12, p = 0.059. The authors called for a large adequately powered trial before routine use, which is what ASCEND-HF became.
- Study in people2005Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure
Small studies said the drug damaged kidneys, and the large one later said it did not. Five small studies covering 1,269 patients were pooled. Kidney function got worse about half as often again on nesiritide as on other treatment. Nobody needed dialysis more often. The 7,141 person study that followed found no extra kidney harm at all. When a big study and a pool of small ones disagree, the big study is the better evidence.
Meta-analysis of 5 randomised studies, 1,269 patients. FDA-approved doses of nesiritide increased worsening renal function against non-inotrope control, relative risk 1.52, 95 percent confidence interval 1.16 to 2.00, p = 0.003. There was no difference in the need for dialysis. ASCEND-HF later found no excess renal harm in 7,141 people.
- Study in people2009Standardizing care for acute decompensated heart failure in a large megatrial: the approach for the Acute Studies of Clinical Effectiveness of Nesiritide in Subjects with Decompensated Heart Failure (ASCEND-HF)
This paper has no patient results in it. It describes how the big nesiritide trial was set up, and in particular how ordinary heart failure care was kept the same at every hospital taking part. That matters, because a drug added on top of care that varies wildly cannot be judged. It sits here as the methods record behind the trial. What the trial found is in the main paper.
The design and conduct paper for ASCEND-HF, describing how background heart failure care was standardised across the trial so that the nesiritide comparison would be interpretable.
- Study in people2018Interaction of Body Mass Index on the Association Between N-Terminal-Pro-b-Type Natriuretic Peptide and Morbidity and Mortality in Patients With Acute Heart Failure: Findings From ASCEND-HF
Body weight does not change what this blood test tells a doctor. 686 people from the big nesiritide trial had the test done when they arrived. Heavier people had lower readings, as expected. A higher reading still predicted death within six months, whatever a person weighed. It did not predict anything at 30 days. This is the peptide used as a blood test rather than as a drug, and in that role it works.
686 patients from ASCEND-HF with NT-proBNP measured on admission. Higher body mass index was associated with lower concentrations, as expected, but body mass index did not modify the prognostic value: a raised admission NT-proBNP predicted 180 day mortality across every weight category, and predicted nothing at 30 days. This is the peptide used as a blood test rather than as a drug, and in that role it holds up.
- Study in people2011A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure (ASCEND-HF)
This is the registry entry for the big nesiritide trial and it holds no results. It records that 7,141 people took part, that the study finished, and that Scios sponsored it. As of 11 September 2026 nothing about the outcome has been posted here. The findings were published in a medical journal instead.
Registry record: phase 3, 7,141 participants enrolled, completed, lead sponsor Scios Inc. No results are posted in the registry record itself as of 11 September 2026.
- Review of studies2014Renal subanalysis of the Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure (ASCEND-HF): the end of nesiritide as a cardiorenal therapeutic?
An editorial that ran with the deeper look at kidney results from the big nesiritide study. Its title says what the field concluded: the kidney case for nesiritide did not survive the study.
Editorial accompanying the ASCEND-HF renal subanalysis. Its title states the conclusion the field drew: the renal case for nesiritide did not survive the trial.
Where to buy BNP and nesiritide
No seller we track lists BNP and nesiritide yet. We read sellers’ public product lists every week, and this section fills in as soon as one does. Every seller, graded
Common questions
Has BNP and nesiritide been tested in people?
Yes. 7,149 people given it across 3 completed trials cited here, 1 of which found nothing. BNP is a heart hormone with two lives. As a blood test, it is the standard way to check for heart failure. As a drug, it failed. In a study of 7,141 people, the drug version, nesiritide, barely helped breathing and did not change deaths or return trips to hospital. The product is now listed as discontinued.
What is the BNP and nesiritide dosage?
No human dose established. Amounts that were given in studies sit in Human evidence on this page. None of them is a personal dose. 3 completed trials, 7,149 people given it
Is BNP and nesiritide FDA-approved?
NATRECOR (nesiritide), NDA 020920, Scios LLC, first approved in 2001 for heart failure that has suddenly got worse. When we checked the FDA drug database (Drugs@FDA) on 11 September 2026, it was listed Discontinued. A Federal Register notice says it was not discontinued or withdrawn because of safety or because it did not work. BNP and NT-proBNP are still used every day as blood tests to help diagnose. That is a lab use, not a drug approval.
What is the difference between BNP the blood test and nesiritide the drug?
They are the same hormone used two ways. The blood test measures the BNP your own heart releases, or its inactive piece NT-proBNP, to spot heart failure and judge how bad it is. Nesiritide is a lab-made version given by drip as a treatment. The test is routine. The drug is discontinued.
Why was nesiritide discontinued?
Because of ASCEND-HF, a study of 7,141 people paid for by the maker. The drug did not cut deaths or return trips to hospital. It only helped breathing a little, not enough to count, and it caused more low blood pressure. The FDA record lists NATRECOR as discontinued. It also carries a government finding that it was not pulled for safety or effectiveness reasons.
Did nesiritide damage the kidneys?
A 2005 review of 5 small studies found kidney function got worse 52 percent more often. ASCEND-HF was far larger, and it found no extra harm: 31.4 percent against 29.5 percent, a gap that could be chance. The large study is the better evidence, and it did not confirm the kidney worry.
Is a high BNP result dangerous in itself?
A high BNP or NT-proBNP is a sign of strain on the heart, and it predicts worse outcomes. That is why doctors measure it. It is a sign of the problem underneath, not something to treat on its own. And giving the hormone as a drug did not improve outcomes when it was tested.