21.有關特定病人與高血壓首選藥品的配對，下列何者正確？
(A)左心室衰竭病人：amlodipine
(B)勃起功能障礙男性：clonidine
(C)缺血性心臟疾病病人：hydrochlorothiazide
(D)無合併症之50歲男性：indapamide

(A)心衰竭的病人： ACEI (或ARB) BB(carvedilol, metoprolol 與 bisoprolol)與mineralocorticoid receptor antagonist(如spironolacton)，水腫的情形可add on loop diuretics，如furosemide

(B) Clonidine是中樞的alpha-2 agonist，ADR 包括sexual dysfuction，其中methyldopa使用者有1/3會發生

(C)post-MI/clinical CAD用：ACEI 或ARB+BB

(D)在monotherapy時，thiazide優於ACEI/ARB或CCB

(A)左心室衰竭病人：amlodipine diuretic+ACEi or ARB, then add beta-blocker，再不行就加上aldosterone antagonist(如spironolactone)
(B)勃起功能障礙男性：clonidine →副作用有性慾減低，不建議用於勃起障礙男性
(C)缺血性心臟疾病病人：hydrochlorothiazide 

缺血性心臟疾病(IHD)可由ACS或是MI來呈現，首選都是beta-blocker，加上ACEi or ARB 
(D)無合併症之50歲男性：indapamide →monotherapy為ACEi、ARB、CCB or thiazide-type diuretic

(A) 不當，因為CCB有負向強心作用，會惡化心衰竭

(B) 不當，clonidine可能引起性功能障礙

(C) 效果有限，要用也用aldosterone antagonist (spironolactone)

換考黑人種族的話ACEI/ARB效果不佳用thiazide或CCB喔!

Calcium channel blockers in heart failure with reduced ejection fraction

Calcium channel blockers (except amlodipine and felodipine) should generally be avoided in patients with heart failure with reduced ejection fraction (HFrEF) since they provide no functional or mortality benefit and some first generation agents may worsen outcomes.

Amlodipine and felodipine appear to be safe and well tolerated in patients with HFrEF and can be used for the treatment of hypertension or angina. However, ACEI and beta blockers, both of which improve survival among patients with HFrEF, should be given first in patients with hypertension and beta blockers should be given first in patients with angina or atrial fibrillation.

https://www.uptodate.com/contents/calcium-channel-blockers-in-heart-failure-with-reduced-ejection-fraction?search=chf%20ccb&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H12