Nesiritide is a human brain type natriuretic peptide. The addition of nesiritide, a balanced venous and arterial dilator for the treatment of decompensated heart failure, is the first intravenous (IV) therapy developed in the past decade. Nesiritide binds to receptors in the kidneys, vasculature, and other organs to produce vasodilation and natriuresis. These effects act to reduce ventricular filling pressures and rapidly improve symptoms of heart failure. Nesiritide reduces pulmonary capillary wedge pressure and pulmonary artery pressure, improves the cardiac index, and has minimal effects on heart rate. The limiting side effect of nesiritide is dose-related hypotension. It should not be used in patients with suspected or measured low filling pressures or patients with baseline hypotension. Current literature supports the efficacy of nesiritide; however, there are very few outcome data demonstrating the superiority of nesiritide over conventional therapy. Because this vasodilator does not require hemodynamic monitoring for utilization, it may be an attractive agent for a defined group of patients with decompensated heart failure.
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