The authors start out with the very promising statement “This report takes a rigorous, evidence-based approach to recommended treatment thresholds, goals and medications in the management of hypertension in adults.” Given that within 1 month 3 different sets of hypertension guidelines have surfaced in the United States, this statement is prone to inspire confidence. However, when one looks at the linchpin of the guidelines, that is, the box of recommendations for the management of hypertension, one rapidly becomes disheartened. Of the 10 recommendations, only 2 are grade A (based on evidence that the net benefit is substantial), 2 are grade B (evidence that the net benefit is moderate to substantial or there is high certainty that the net benefit is moderate), 1 is grade C (evidence that there is a small net benefit), and no less than 6 are grade E (expert opinion, insufficient evidence or evidence is unclear or conflicting). Of note, recommendation 1, which was classified as evidence-based grade A, could not be accepted by all the authors and had therefore to be supplemented with a “corollary recommendation” that was solely eminence based, that is, expert opinion grade E. Does this indicate that some authors believed that their own (expert) opinion was preferable to objective evidence? Clearly therefore, although the intentions were good, execution did fall short. This may not necessarily be the authors’ fault; evidence simply may not have been available to fully support somewhat overambitious recommendations. Thus, as has been the case with most American College of Cardiology/American Heart Association guidelines in the past, “for the majority of the recommendations in the Eighth Joint National Committee hypertension guidelines, eminence continues to trump evidence.”