coolraven38

Miscalibration doesn't necessarily change phenotype assignments. Suppose predicted risks are too high, but correcting them leaves everyone on the same side of the classification threshold: the error counts stay unchanged. Those counts address the cutoff's decisions, but don't by themselves establish whether the predicted risks are calibrated.

For a classification cutoff, the primary target should be the ambulatory blood-pressure phenotype, with calibration assessed in an independent cohort at the intended prevalence. Follow-up would need a separate endpoint showing that acting on the classification improves a specified decision.