Aim of the present study is to investigate the clinical efficacy of recombinant human brain natriuretic peptide (rhBNP) and dopamine combination treatment in patients with cardiorenal syndrome type 4 (CRS4) combined with hypotension. A total of 160 CRS4 patients admitted to our hospital from July 2010 to December 2014 were recruited, and were randomly divided into two groups, the observational group (n=80) and the control group (n=80). CRS4 patients treated with dopamine were recruited into the control group. Patients in the observational group were given rhBNP and dopamine combination treatment once every 8 h. Both groups received conventional treatments and the course of treatment was 7 days. Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), serum creatinine (SCr), N-terminal brain natriuretic peptide precursor (Nt-proBNP), creatinine clearance (CCr), left ventricular end-diastolic diameter (LVEDd), left ventricular ejection fraction (LVEF), Stroke volume (SV), urine volume and adverse reactions before and after treatment were compared. The observational group showed significant changes in the levels of SBP, DBP and HR compared with the control group (P<0.05). The levels of SCr and Nt-proBNP decreased significantly in the observational group than those in the control group (P<0.05). The levels of CCr, LVEF, SV and urine volume increased significantly in the observational group than those in the control group (P<0.05). Patients in the observational group had mild and tolerable adverse reactions. rhBNP combined with dopamine infusion has good clinical efficacy and mild adverse effects in treatment of CRS4.