Abstract: Volume overload is an important pathophysiological process in the development of acute and chronic heart failure. Although mortality has been markedly reduced with the successive introduction of neurohormonal regiments in heart failure with reduced ejection fraction(HFrEF), no clinical trial has yet demonstrated the benefits with pharmacotherapeutic volume-based interventions in the acutely decompensated individual or those with evolving congestive chronic heart failure. Identifying therapies that have the potential to aid in diuresis more safely and efficaciously is paramount to decreasing inpatient length of stay and preventing unnecessary admissions. Recently, a large number of clinical trials have been dedicated to the use of vasopressin antagonists, especially tolvaptan. The results show that tolvaptan has chinical benefits in some specific clinical situations. This review summarizes the literature surrounding the use of tolvaptan in congestive heart failure volume overload, so as to provide guidance for clinical practice.