The natriuretic peptides are a family of related hormones that play an important role in the homeostasis of cardiovascular system. Serum levels of brain natriuretic peptide have recently emerged as a marker for the diagnosis, prognosis, follow-up, and therapy of patients with heart failure (HF) and other cardiovascular diseases. Its diagnostic role is important in valvular heart diseases, such as in severe aortic stenosis and mitral regurgitation, and in acute coronary syndromes, right ventricular dysfunction, and diastolic left ventricular dysfunction. The administration of recombinant brain natriuretic peptide in patients with acute decompensated HF has been a hot topic for the current clinical practice. Its use in patients with HF has a clinically important intermediate-term benefit without an associated increase in risk. Furthermore, it seems to have an important role in improving the hemodynamic parameters in patients with pulmonary hypertension secondary to HF and in improving postoperative renal function after coronary artery bypass grafting.