Comparative Effectiveness of Oral Hypoglycemic Combinations in Type 2 Diabetic Patients with Comorbid Hypertension at General Hospitals in Rivers State, South South Nigeria

Type 2 diabetes mellitus frequently coexists with hypertension, creating complex pharmacotherapy management challenges and heightened cardiovascular risk. Selecting optimal oral hypoglycemic combinations in this population requires comparative effectiveness evidence from local hospital settings. This study evaluated the comparative effectiveness of commonly used oral hypoglycemic agent combinations in type 2 diabetic patients with comorbid hypertension at general hospitals in Rivers State, South South Nigeria. A retrospective cohort study analyzed 400 patient records over 30 months from four general hospitals, comparing three common combination regimens: metformin plus glibenclamide, metformin plus glimepiride, and metformin plus sitagliptin. Primary outcomes were glycated hemoglobin reduction, fasting plasma glucose control, and rate of hypoglycemic episodes at 12-month follow-up. Secondary outcomes included blood pressure control and renal function changes. Metformin plus sitagliptin demonstrated significantly greater glycated hemoglobin reduction at 1.8 percent compared to 1.3 percent for metformin plus glibenclamide, with a lower rate of hypoglycemic episodes. Blood pressure control was comparable across regimens. Renal function deterioration was numerically lower in the sitagliptin group. However, treatment cost was substantially higher for the sitagliptin combination. These findings provide clinically relevant evidence for individualized therapy selection in comorbid diabetic-hypertensive patients and highlight the need for pharmacoeconomic considerations alongside clinical effectiveness data. Keywords: oral hypoglycemic agents, type 2 diabetes, hypertension, Rivers State, comparative effectiveness