Objective To investigate the effects of treatment with tolvaptan on cardiac function and vascular endothelial function in elderly patients with chronic heart failure(CHF).Methods A total of 72 elderly patients with CHF admitted to the department of cardiovascular medicine,People's Hospital of Shaodong from January 2022 to December 2023 were selected and divided into control group(n=36)and observation group(n=36)by random number table method.The control group was treated with conventional diuretic drugs(furosemide tablets),and the observation group was treated with tolvaptan.The clinical efficacy,serum nterminal pro-brain natriuretic peptide(NT-proBNP),serum sodium level,cardiac function and vascular endothelial function were compared between the two groups of CHF patients.Results The total effective rate of the observation group was 94.44%,which was higher than 75.00%of the control group,and the difference was statistically significant(P<0.05).After treatment,the level of NT-proBNP in the observation group was(810.27±45.68)μg/L,which was lower than(1 247.63±51.17)μg/L in the control group,and the serum sodium level in the observation group was(139.25±5.51)mmol/L,which was higher than(134.81±4.98)mmol/L in the control group,and the differences were statistically significant(P<0.05).The level of left ventricular ejection fraction(LVEF)in the observation group was(51.75±2.84)%,which was higher than(48.36±3.25)%in the control group,the left ventricular end-diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD)levels in the observation group were(53.98±7.31)mm and(45.23±4.45)mm,respectively,which were lower than(57.56±6.07)mm and(49.61±4.32)mm in the control group,the differences were statistically significant(P<0.05).The nitric oxide(NO)and calcitonin gene related peptide(CGRP)levels in the observation group were(80.12±6.32)μmol/L and(49.25±4.67)mg/L,respectively,which were higher than(65.12±3.45)μmol/L and(35.26±3.17)mg/L in the control group,the endothelin(ET)level in the observation group was(70.47±5.47)ng/L,which was lower than(85.24±6.29)ng/L in the control group,the differences were statistically significant(P<0.05).Conclusion Torvaptan has significant clinical efficacy in the treatment of elderly patients with CHF,effectively improving cardiac function indicators,and helping to restore vascular endothelial function to normal state.