Comparison of the efficacy of tolvaptan and furosemide in the treatment of elderly HFpEF patients

XIE Aiming; GU Shunzhong

doi:10.3969/j.issn.1672-8157.2026.03.028

Abstract：Objective To compare of the clinical efficacy of tolvaptan and furosemide in the treatment of elderly patients with heart failure with preserved ejection fraction(HFpEF).Methods A retrospective cohort study was conducted.A total of 146 elderly patients with HFpEF admitted to Department of Cardiology,Hai'an People's Hospital from January 2023 to December 2024 were enrolled from the medical record system and divided into groups based on the main diuretic treatment regimen actually received during hospitalization:75 patients who received conventional intravenous furosemide injection were assigned to the conventional group,and 71 patients who received oral tolvaptan were assigned to the tolvaptan group.The clin-ical efficacy,cardiac function indicators,serum creatinine,24-hour urine output,daily total fluid intake before and after treat-ment,and the incidence of adverse reactions during treatment were compared between the conventional group and the tolvaptan group.Results The total effective rate was 83.10%(59/71)in the tolvaptan group and 66.67%(50/75)the conventional group,with the tolvaptan group showing a significantly higher rate(χ2=5.205,P=0.023).After treatment,left ventricular end-systolic diameter and left ventricular end-diastolic diameter in the tolvaptan group were(36.12±3.97)and(49.21±3.93)mm,respective-ly,lower than those in the conventional group((41.38±4.55)and(52.09±4.18)mm),with statistically significant differences(t=7.426,4.284,both P<0.05).After treatment,serum creatinine in the tolvaptan group was(92.46±8.83)μmol/L,lower than that in the conventional group((108.97±9.60)μmol/L),while the 24-hour urine output in the tolvaptan group was(1 983.71±238.04)mL,higher than that in the conventional group((1 813.58±217.62)mL),with statistically significant differences(t=10.798,4.511,both P<0.05).After treatment,there was no statistically significant difference in the daily total fluid intake between the two groups(t=1.883,P>0.05).There was no statistically significant difference in the incidence of adverse re-actions between the tolvaptan group and the conventional group(26.76%(19/71)vs 24.00%(18/75),χ2=0.147,P=0.702).Conclusion Compared to furosemide,tolvaptan can better improve the total treatment efficacy and diuretic effect in elderly patients with HFpEF,simultaneously improving cardiac and renal function,with a favorable safety profile.