Background. Hypertension is an established risk factor for small-vessel cerebral stroke and the renin-angiotensin system plays an important role in the maintenance of blood pressure. We aimed at evaluating the contribution of the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism to the risk of small-vessel stroke in south Indian population. Materials and Methods. We investigated 128 patients diagnosed with small-vessel stroke and 236 age, and gender-matched healthy controls. ACE I/D polymorphism was detected by polymerase chain reaction. Results. Hypertension was significantly more prevalent in the patient group and was associated with 6-fold increase in risk for stroke. ACE genotypes were in Hardy-Weinberg equilibrium in both patients and controls. Prevalence of DD, ID, and II genotypes in cases (34.4%, 43.7%, and 28%) did not differ significantly from controls (31.8%, 43.2%, and 25%). The polymorphism was not associated with small-vessel stroke (OR: 1.34; 95% CI: 0.52–1.55). However, diastolic blood pressure was associated with the ACE I/D genotypes in the patients. (DD; ID; II; ？mm Hg, . Conclusion. Our study showed that hypertension, but not ACE I/D polymorphism, increased the risk of small-vessel stroke. 1. Introduction Brain infarction due to ischemia in the perforating arteries which supply the brain white and deep grey matter nuclei, also known as lacunar infarction or lacunar stroke, accounts for 20% to 25% of all ischemic strokes [1]. Lacunar infarct forms part of the spectrum of cerebral small-vessel disease (SVD) which affects the brain diffusely and is the commonest vascular cause of cognitive impairment [2]. The prevalence rate of stroke in India varies across regions. While the prevalence is 5.4 per 1000 persons in the eastern part of India [3], southern India has reported a prevalence of 1.36 per 1000 persons [4]. The Indian Collaborative Acute Stroke Study (ICASS), a recent multicenter study conducted among 2162 admitted stroke patients across India, observed ischemic stroke in 77%, hemorrhagic stroke in 22%, and unspecified stroke in 1% of cases [5]. Data from a hospital-based stroke registry from south India shows that, of all ischemic stroke patients, 41%, 18%, 10%, 4%, and 27% were classified as large-artery atherosclerosis, lacunae, cardioembolism, other determined etiology, and undetermined etiology, respectively [6]. Hypertension, diabetes, and smoking were the common risk factors among all the subtypes [7], similar to other populations. Hypertension is considered the foremost risk factor for lacunar
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