Hello! Welcome and thank you for asking on HCM! These blood pressure values are really high and they impose your father to a high risk for intracranial bleeding. For this reason, if he has motor deficits or gait troubles, I would recommend performing a brain CT scan. From the other hand it is important performing further tests to investigate for the possible cause of these blood pressure spikes: - thyroid hormone levels for thyroid dysfunction - cortison and aldosterone plasma levels for adrenal gland dysfunction - urinary metanephrines for possible pheochromocytoma - an abdominal ultrasound to examine the blood flow in the renal arteries and the kidney structure - blood electrolytes for possible imbalance - PCR and ESR for inflammation. You should discuss with his doctor on the above issues. If no possible cause is found, I would recommend making some changes to his anti-hypertensive therapy (increase the doses or add on new drugs), in order to have a better control of high blood pressure. Reducing salt and caffeine intake in his diet will help lower naturally high blood pressure values. Hope to have been helpful! Kind regards, Dr. Iliri