Objectives: This study investigated regional dietary patterns and their association with hypertensive dyslipidemia multimorbidity among older Chinese adults. Methods: Data from 13,809 individuals (aged ≥ 65 years) were extracted from the 2015–2017 China Nutrition and Health Surveillance. Hypertensive dyslipidemia multimorbidity was defined as concurrent hypertension and dyslipidemia. Four dietary patterns were identified via exploratory factor analysis using 3-day 24 h dietary records. Results: Four dietary patterns were extracted: traditional southern, diverse, high oil and salt, and animal oil–other animal meat–coarse grain pattern. The national prevalence of hypertensive dyslipidemia multimorbidity was 31.9%, with significant regional variation (highest in North China: 36.4%; lowest in Central China: 27.9%; p < 0.0001). Regional dietary dominance included: the traditional southern pattern in South China (75.9%); the traditional southern (35.8%) and diversified (28.8%) patterns in East China; animal oil–other animal meat–coarse grain (38.4%) and traditional southern (37.9%) patterns in Southwest China; high oil and salt (36.8%) and traditional southern (25.9%) in Central China; diversified (47.7%) and high oil and salt (26.3%) patterns in North China; high oil and salt (44.9%) and diversified (37.9%) patterns in Northwest China; and the diversified (46.9%) pattern in Northeast China. In the highest scoring group of the animal oil–other animal meat–coarse grain pattern, the risk of hypertensive dyslipidemia multimorbidity was 1.179 times greater compared with the lowest scoring group (Q4 vs. Q1, OR = 1.179, 95% CI: 1.032–1.316, p < 0.001). Region-specific analyses highlighted: increased risks with the traditional southern pattern in South/East China (Q4 vs. Q1, OR = 2.080, 95% CI: 1.036–4.175, p < 0.001) and (Q4 vs. Q1, OR = 1.734, 95% CI: 1.052–2.859, p < 0.001); protective effects of the diversified pattern in Northwest China (Q4 vs. Q1, OR = 0.377, 95% CI: 0.173–0.824, p < 0.001); elevated risks with the high oil and salt pattern in Central/North China (Q4 vs. Q1, OR = 2.343, 95% CI: 1.107-4.955, p < 0.001) and (Q4 vs. Q1, OR = 1.837, 95% CI: 1.019–3.312, p < 0.001); and higher risks with the animal oil–other animal meat–coarse grain pattern in Southwest China (Q4 vs. Q1, OR = 2.009, 95% CI: 1.004–4.021, p < 0.001). Conclusions: In conclusion, dietary patterns among elderly Chinese are diversified and should be optimized based on local food resources to control hypertensive dyslipidemia multimorbidity.