Hello! Welcome and thank you for asking on HCM! I passed carefully through your question and would explain that single spikes of blood pressure are not indicative of uncontrolled high blood pressure. They could be related to physical activity or emotional stress. Coming to this point, I would recommend you to closely monitor your blood pressure frequently during the day (in sitting position after 10 minutes of total relax) and refer those values to your GP. If your blood pressure values are frequently high, making some changes to your therapy may be needed. I would also recommend performing some tests to investigate for secondary causes of high blood pressure: -a chest X ray study - complete blood count - kidney and liver function tests - fasting glucose - blood electrolytes - PCR, ESR for inflammation - thyroid hormone levels for thyroid dysfunction - cortisol and aldosterone for adrenal gland dysfunction - an abdominal ultrasound to examine the renal arteries. You should discuss with your doctor on the above tests. Meanwhile, I would recommend some lifestyle changes to help maintain a normal blood pressure naturally: - reduce salt and caffeine intake - perform regularly physical activity (walking, aeorbics, etc.) - try to lose some pounds if you are overweight. Hope you will find this answer helpful! Kind regards, Dr. Iliri