Editor—We read with interest the recent meta-analysis in which D'Amico and colleagues1 evaluated the association of intraoperative hypotension and postoperative outcomes. Recent insights have challenged long-standing assumptions about the impact of arterial pressure in surgery. D'Amico and colleagues'1 meta-analysis showed that, surprisingly, permissive mean arterial pressure (MAP) management (45–59 mm Hg) was not associated with increased mortality.1 The largest cohort in the meta-analysis was from the POISE-3 trial.