Hypertension and dementia are common illnesses in geriatric patients, resulting in significant morbidity and mortality. The objective of this study was to investigate racial and ethnic differences in blood pressure control and medication utilization in veterans aged 65 years or older with a diagnosis of both hypertension and dementia. We conducted a retrospective chart review for such veterans who attended the Michael E. DeBakey VA Medical Center outpatient clinics in Houston, Texas, during the period of October 1, 2003, to September 30, 2004. A total of 304 patients (190 Caucasians and 114 African-Americans) were included in the study. The mean number of concurrent antihypertensive medications for African-Americans was higher than for Caucasians (3.2 and 2.8, respectively; P = 0.02). African-American ethnicity was associated with higher use of thiazide diuretics (P = 0.02), dihydropyridine calcium channel blockers (P = 0.04), and clonidine (P = 0.01) than was Caucasian ethnicity. Forty-eight percent of African-Americans achieved adequate blood pressure control, compared with 59% of Caucasians. Mini-mental state exam scores were lower for African-Americans than for Caucasians (17.8 and 21.6, respectively; P = 0.01). The utilization of dementia medications was not found to be different between African-Americans and Caucasians. Veterans in this cohort achieved better blood pressure control than previously reported in other studies consisting of older patients. Physicians might have considered patients' race when prescribing antihypertensive medications reflected by the higher use of thiazide diuretics and calcium channel blockers for African-Americans.