We have read the interesting comment by Giustiniano and Nisi1  about our article.2  The authors highlight that the diastolic arterial blood pressure can decrease significantly when the Hypotension Prediction Index (hereafter the Index) reaches approximately 50 and argue for the possible need for treatment when diastolic arterial blood pressure is very low. We appreciate the comment and would like to highlight additional aspects that probably need to be considered in this context.

First, Giustiniano and Nisi mention the “gray zone” as the reason for commenting on our publication. We want to stress that the exclusion of “gray-zone” outcomes (mean arterial pressure [MAP] between 65 and 75 mmHg) is not our primary concern with the method used to develop and validate the Index. Our primary concern is that the method also enforces that the prediction data for nonhypotension cannot have a MAP less than 75 mmHg, while the...

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