### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
Here is what is happening or happened: - Blood pressure keeps spiking to 167/90 throughout the day - The past week my BP has been going from 146/80 to 167/90 - Woke up around 3:00 am with huge pressure in head and I can feel that BP was up, when measured it was 167/90. - During the day it spikes , I do not measure but can feel it especially in head. - After waking from sleep with BP raised my arms feel as if I was sleeping on them. - Ringing in ears. - Very real dreams every now and then. - Sex drive normal. - Difficulty sleeping because of the above symptoms. - Sometimes will wake up from a very real dream and feel the pressure etc but when measured has been around 138/86, today was the first time I woke up from sleep with pressure in head and elevated BP. I am taking 25Mg Metoprolol twice daily early morning and early evening. I am also taking Lisinopril 40Mg once a day. I have not started the diarectic as not sure what is going on and feel it may make things worst.

### output:

Hello, I would explain that considering your situation, it is important performing some tests in order to investigate for a possible metabolic disorder: - complete blood count, PCR, ESR for inflammation- thyroid hormone levels for thyroid gland dysfunction- kidney and liver function tests-blood electrolytes.  Increasing the dose of metoprolol or adding a calcium channel blocker (amlodipine, lercanidipine) to your therapy may be needed.  Hope I have answered your query. Let me know if I can assist you further. 