To reduce cardiac-wall stress and possibly myocardial injury in patients with acute heart failure, early intervention with an intravenous vasodilator has been proposed. Researchers conducted a double-blind trial by randomly assigning more than 2,100 patients with acute heart failure to receive a continuous I.V. infusion of either ularitide at a dose of 15 ng per kilogram of body weight per minute or matching placebo for 48 hours, along with accepted therapy. Coprimary outcomes were death from cardiovascular causes during a median follow-up of 15 months and a hierarchical composite endpoint assessing the initial 48-hour clinical course. Death from cardiovascular causes occurred in 21.7% (236) of the patients in the ularitide group and 21% (225) of the patients in the placebo group. The ularitide group experienced greater reductions in systolic blood pressure and in levels of N-terminal pro–brain natriuretic peptide than the placebo group. The authors note, however, that changes in cardiac troponin T levels during the infusion did not differ between the two groups in the 55% of patients with paired data. While ularitide reduced cardiac-wall stress more than placebo, the researchers report that, "in an intention-to-treat analysis, the drug did not reduce myocardial injury (as indicated by cardiac troponin T levels), did not affect a clinical composite endpoint, and did not influence disease progression, as shown by the lack of effect on cardiovascular mortality."