What can cause blood pressure to spike for no reason even on bp medicine? what should i have done?

Many factors for BP: There are different factors that can influence one's BP. UR a little young to have HTN so you should have a w/u for other causes other than hereditary. Ask ur PCP to look for them. Outside of that, make sure you're not eating or drinking or taking OTC meds that can incr BP, ie salty foods, caffeine, alcohol, cold or allergy medications. Also poor sleep/exercise or stress among other factors.