The aim of this study was to evaluate serial measurements of B-type natriuretic peptide (BNP) and NT-proBNP levels in the detection of myocardial ischemia. A total of 62 consecutive male patients referred for stress echocardiography in a tertiary care cardiology center were enrolled. Inducible myocardial ischemia was detected in 15 patients (24%). BNP and NT-proBNP levels were significantly lower in patients with ischemia compared to those without ischemia throughout exercise testing and during recovery (p<0.05 for all comparisons). Major differences in baseline characteristics including age and higher incidence of comorbidities including hypertension and kidney disease in patients without ischemia apparently outweighed myocardial ischemia as trigger for BNP and NT-proBNP secretion. The same factors may have induced a selection bias in the decision to offer direct coronary angiography or initial stress testing. In conclusion, BNP and NT-proBNP are not helpful in the evaluation of male patients with suspected myocardial ischemia in a tertiary care cardiology center with rapid access to coronary angiography.