The aim of the present study was to investigate the association between the ACE gene I/D polymorphism and the development of hypertensive encephalopathy (HE) in Uzbek patients with hypertension (HT). Materials and methods: The study included 91 male patients aged from 32 to 74 years (mean age 52.5±9.2) with HT Grade 1, 2 and 3 (ESH/ESC, 2013) [4] and presence of HE. All patients were checked on office BP using Korotkov’s method and ambulatory blood pressure monitoring (ABPM). Intima-media thickness (IMT) of the carotid artery was measured by a 7.5MHz high-resolution ultrasound. Genomic DNA was isolated from peripheral blood using the DiatomTM DNA Prep 200 Kit according to the manufacturer's protocol. ACE gene I/D polymorphism genotypes were determined by PCR. Results: Among HT patients with HE, we have identified a statistically significant predominance of ID genotype carriers (65.9%) against carriers of the II genotype (18.75) and DD genotype (15.4%) (P=0.000); the frequency of I and D alleles was 51.6% and 48.4%, respectively (P>0.05). Comparative analysis showed a possible association between the ID genotype/D allele and HE development in HT patients, according to the general model (OR = 6.36; 95% CI 3.04 -13.31; p=0.000) and multiplicative model (OR = 2.02; 95% CI 1.25 -3.27; p=0.004) of inheritance. High grades of HT were predominant in carriers of the DD genotype. IMT was significantly higher in carriers of the DD genotype than in carriers of the II and ID genotypes. The carriage of D allele was associated with the highest levels of TC, TG, and VLDL-C. Carriers of the DD genotype were characterized by higher values of daytime SBP, nighttime SBP variability and nighttime SBP load.