Why Your Blood Pressure Matters More Than You Think | Dr. Heather Prendergast

Jul 9

Most of us think about healthcare as something that happens inside a doctor's office or a hospital. We picture annual physicals, specialist appointments, surgeries, and follow-up visits. But for many people, healthcare begins somewhere very different. It begins in the emergency department.

During my conversation with Dr. Heather Prendergast, professor of emergency medicine and Vice Dean for Clinical Affairs at the University of Illinois College of Medicine, I was reminded that the emergency department offers a perspective on our healthcare system that few other specialties experience. After more than thirty years in emergency medicine, she has cared for patients from every background, every stage of life, and every circumstance imaginable. While emergency physicians are trained to make rapid decisions during moments of crisis, they also witness something many of us don't always see: the long chain of events that often leads someone to that crisis in the first place.

As an orthopedic surgeon, I often meet patients after an injury changes the course of their day, their month, or sometimes even their life. My focus is helping them recover and return to the activities they love. But listening to Dr. Prendergast reminded me that recovery doesn't always start after a diagnosis. Sometimes it starts by understanding everything that happened before the diagnosis ever existed.

The Story Behind the Patient

One of the things that stood out most during our conversation was the way Dr. Prendergast described the emergency department as the healthcare system's safety net. While many people arrive because of an unexpected emergency, others come because they have nowhere else to turn. They may not have insurance, a primary care physician, reliable transportation, or the ability to take time away from work for routine medical appointments. By the time they reach the emergency department, what could have been managed months earlier has often become far more serious.

It made me think about how easy it is to focus only on the condition in front of us. We diagnose heart failure, uncontrolled diabetes, or dangerously high blood pressure, but those diagnoses rarely tell the whole story. Behind every medical problem is a person whose health has been shaped by countless factors outside the walls of the hospital.

We often talk about personal responsibility in healthcare, and certainly our daily choices matter. But our choices are also influenced by the opportunities available to us. It is difficult to prioritize healthy eating when fresh food is expensive or unavailable. It is difficult to exercise consistently when your neighborhood doesn't feel safe. It is difficult to manage a chronic condition when seeing a physician means losing wages or arranging transportation you don't have.

Those realities don't excuse disease, but they do help explain it.

Why Prevention Isn't Always Simple

Our conversation naturally shifted toward hypertension, an area Dr. Prendergast has dedicated much of her career to studying. High blood pressure is one of the most common medical conditions we treat, yet it remains one of the easiest to ignore because it rarely announces itself with obvious symptoms.

As physicians, we often tell patients to "know your numbers," but hearing Dr. Prendergast explain why made me appreciate just how important that advice really is. She has spent years caring for patients whose first indication that something was wrong wasn't a mildly elevated blood pressure reading. It was a stroke, heart failure, or kidney disease.

What I appreciated most was that she never reduced the conversation to simply telling patients to eat better or exercise more. Instead, she spoke about education and empowerment. She described helping patients understand how sodium hides in processed foods, how sleep affects cardiovascular health, how alcohol can influence blood pressure, and how small, sustainable changes often make a meaningful difference over time.

That approach resonated with me because lasting behavior change rarely happens through fear. People are far more likely to care for themselves when they understand not only what they should do, but why it matters and how to realistically incorporate those changes into their lives.

Building Trust Before Giving Advice

Another part of our conversation that stayed with me centered around misinformation and the challenge physicians face as patients increasingly arrive with information gathered from social media, podcasts, and the internet. While misinformation can certainly create frustration, Dr. Prendergast offered a perspective that felt both refreshing and practical.

She spoke about meeting patients where they are.

Rather than immediately correcting someone or dismissing their concerns, she begins by listening. She wants to understand why they believe what they believe before trying to change their mind. She shared a story about caring for a child whose mother had delayed vaccinations after being influenced by misinformation online. Instead of approaching the conversation with judgment, Dr. Prendergast answered questions, acknowledged the mother's concerns, and built trust throughout the hospitalization. By the time the child was discharged, the mother wanted to know how to catch up on the recommended vaccines.

It reminded me that trust is often the foundation of good medicine.

Patients are far more likely to hear our recommendations when they first feel heard themselves.

Whether we are discussing surgery, medications, rehabilitation, or preventive care, meaningful conversations begin with curiosity rather than assumptions.

Redefining Resilience

Because this podcast explores resilience, I asked Dr. Prendergast how decades in emergency medicine have shaped her own understanding of that word. I expected her answer to focus on perseverance or overcoming adversity. Instead, she offered something that has stayed with me ever since.

She said resilience is not just about overcoming barriers. It's about removing them.

The more I thought about that statement, the more powerful it became.

We often admire people for pushing through difficult circumstances, and there is certainly strength in doing so. But healthcare should also challenge us to ask why those barriers existed in the first place. If someone struggles to access preventive care because of transportation, finances, education, or systemic inequities, resilience should not rest solely on that individual's ability to navigate those obstacles. As physicians and healthcare leaders, we also have a responsibility to identify barriers that can be changed and work toward creating systems that better support the people we serve.

That philosophy has clearly influenced every part of Dr. Prendergast's career, from her research on hypertension to her leadership in academic medicine and her commitment to mentoring the next generation of physicians. Rather than simply celebrating resilience, she has dedicated herself to creating more opportunities for others to succeed.

Final Thoughts

What stayed with me after speaking with Dr. Prendergast is that medicine is about far more than treating the condition that brings someone into the hospital. Every diagnosis represents a much larger story, one shaped by environment, education, access, trust, and opportunity.

As physicians, we will always strive to provide the best possible care in the moments that matter most. But perhaps we should spend just as much time asking what happened before our patients arrived and what can be done to prevent the next crisis from occurring.

The emergency department will always be there when people need it. The greater challenge is ensuring that fewer people need it in the first place.

That kind of work doesn't happen through a single prescription or procedure. It happens through education, partnership, prevention, and a willingness to see the person behind the diagnosis.

After my conversation with Dr. Prendergast, I was reminded that some of the most meaningful changes in healthcare don't begin in the emergency department at all. They begin long before, when we invest in helping people stay healthy enough that they never have to walk through those doors in the first place.