While we cannot exclude that the heart failure may have resulted in an increase in aldosterone synthase expression, on the other hand it is difficult to determine whether the presence of the ACE I/D polymorphism may have played a contributing role in this setting, except that it likely worsened the degree of hypertension and reduced the response to ACE-inhibitors which had been used for several years to treat the patient. This evidence concerns the gene ACE and hypertensive disorder.