Abstract: AIM: To observe the therapeutic effect of brain natriuretic peptide (BNP) in the treatment of severe congestive heart failure. METHODS: Recombinant BNP was used based on basic anti-heart failure treatment in 44 patients with severe congestive heart failure and heart function classified as New York Heart Association (NYHA) IV. Changes in heart rate, blood pressure, central venous pressure, renal function, plasma BNP level, left ventricular end-diastolic diameter (LVEDD) and left ventricular ejection fraction (LVEF) after treatment were observed to evaluate BNP effect. RESULTS: After treatment, clinical symptoms in 40/44 cases were alleviated and the total response rate was 90.9%. Diuresis increased significantly and, at the same time, heart rate, central venous pressure and plasma BNP level decreased markedly. LVEDD was reduced and LVEF was improved. No obvious changes were observed in blood pressure and renal function. CONCLUSION: Recombinant BNP markedly alleviated the clinical symptoms of heart failure. It is a safe and effective treatment for severe congestive heart failure.