Results from the TRUE-AHF trial on ularitide show that early administration of this intravenous vasodilator to patients with acute heart failure (HF) reduces systolic blood pressure and plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), but has no effect on the coprimary end point of initial 48-h clinical course and long-term cardiovascular mortality. This double-blind trial included 2,157 patients with acute HF who were randomly assigned to receive continuous intravenous infusion of either ularitide (15 ng per kg of body weight per min) or placebo for 48 h. Despite the early beneficial effects of ularitide in reducing systolic blood pressure, plasma levels of NT-proBNP, and rate of in-hospital heart-failure events during the infusion, changes in cardiac troponin T levels between baseline and 48 h were similar in both groups, and no significant between-group differences were found for the coprimary outcomes of initial 48-h clinical course and cardiovascular mortality (median follow-up 15 months).