What sign would warrant concern for superimposed preeclampsia in a patient with chronic hypertension?

New-onset proteinuria is a significant indicator that may suggest the onset of superimposed preeclampsia in a patient with preexisting chronic hypertension. In chronic hypertension without the development of preeclampsia, protein levels in the urine typically remain stable. The presence of new proteinuria, particularly when it is detected after the 20th week of gestation or in a patient known to have chronic hypertension, raises concern for progression to preeclampsia. This condition is characterized by hypertension and signs of systemic involvement, including kidney damage evidenced by proteinuria.

Routine headache relief, consistent blood pressure readings, and minimal facial swelling do not directly indicate the development of superimposed preeclampsia. While persistent or severe headaches could potentially be a symptom of preeclampsia, the act of obtaining relief from headaches does not suggest deterioration in the patient's condition. Similarly, stable blood pressure readings imply that the patient's hypertension is controlled and not worsening, which would be expected in the absence of preeclampsia. Minimal facial swelling alone does not serve as a reliable marker for the condition either, as it may not reflect the systemic changes associated with preeclampsia. Therefore, the detection of new-onset protein