Congestive heart failure (CHF) is a life-threatening cardiovascular disease that is increasing in prevalence. It is a common cause of death and is accompanied by high direct and indirect costs for treatment. The current situation faced by patients and the medical community with regard to this ailment is one of high mortality, repeated hospitalizations, and combination therapies. The various classes of pharmacological agents that are currently used for patients suffering from CHF include angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aldosterone antagonists, beta-blockers, calcium channel blockers (CCBs), digitalis drugs, diuretics, inotropic agents, nitrates, and vasodilators. While these agents are all important therapeutic tools in the treatment of CHF, the prognosis for patients with CHF remains poor. Thus improvement of the current pharmacological armamentarium is greatly needed. An endogenous peptide, B-type natriuretic peptide (BNP), has been increasingly utilized in the setting of acute CHF since its approval in 2001. This peptide, or a derivative thereof, has great potential for the treatment of patients at various stages in the progression of heart failure. This review provides an overview of current pharmacological strategies in CHF and addresses potential future developments in the use of BNP for the treatment of CHF.