【Abstract】 Objective To compare the efficacy and safety of recombinant human brain natriuretic titanium (rhBNP) and nitroglycerin (NIT) in treating people with refractory heart failure. Methods 164 patients characterized of refractory heart failure were enrolled in this study. They were randomly assigned to receive NIT (n=84) or rhBNP (n=80). NTproBNP, LVEF, LVEDD, LVESD, overall response rate, the scores of dyspnea, lung rales, systemic edema before and after treatment were compared. Blood pressure and heart rate were measured regularly during and after the administration, and all adverse reactions were recorded. Results NTproBNP, LVEF, LVEDD and LVESD were improved after both rhBNP and NIT treatments. LVEDD and LVESD in rhBNP group were more significantly improved than that of NIT group (P＜0.05). The overall response rate and the scores of dyspnea, lung rales, systemic edema in the rhBNP group were significantly better than that NIT group (P＜0.05). There were no significant difference in NTproBNP or LVEF between the two groups (P＞0.05). There was no significant difference in drugrelated adverse reactions between the two groups (P＞0.05). Conclusion Compared with NIT, rhBNP can significantly improve cardiac function and systemic symptoms in patients with refractory heart failure, and its safety is similar to that of NIT.