Update of acute and long-term tolvaptan therapy.

One of the vasopressin type 2 receptor antagonists, tolvaptan, has been used to treat congestive heart failure patients for over seven years in Japan. Beyond the initially suggested standard procedure, tolvaptan is currently used in patients with acute heart failure soon after their admission or it is used for long-term treatment in the ambulatory situation. Nevertheless, definitive evidence is lacking, particularly for the implication of long-term tolvaptan therapy. Now is the time to update the accumulating evidence and consider the optimal therapeutic strategy for short- and long-term tolvaptan therapy.