Objective To investigate the effect of irbesartan hydrochlorothiazide combined with sodium nitroprusside for injection on left ventricular function and 1-year mortality in patients with acute heart failure. Methods Using random number table method, 98 patients with acute heart failure admitted to our hospital from March 2018 to March 2019 were divided into 2 groups, 49 cases in each. The control group was treated with sodium nitroprusside for injection, and the observation group was treated with irbesartan hydrochlorothiazide combined with sodium nitroprusside for injection. Both groups were treated for 5 days. The left ventricular function indexes and mortality within 1 year of follow-up were compared between the two groups before treatment and after 5 days of treatment. Results After treatment, the left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) of the two groups were lower than the control group, and the left ventricular ejection fraction (LVEF) was higher than the control group. The difference was statistically significant (P<0.05); The mortality rate of the observation group within 1 year was lower than that of the control group, the difference was statistically significant (P<0.05). Conclusion Irbesartan hydrochlorothiazide combined with sodium nitroprusside injection can effectively improve the left ventricular function and prognosis of patients with acute heart failure.