Which organ is NOT directly affected by unmanaged hypertension?

Unmanaged hypertension primarily impacts organs that are highly vascular or have significant blood flow. The brain, heart, and kidneys are directly involved in the regulation of blood pressure and can suffer from the adverse effects of high blood pressure. For example, unmanaged hypertension can lead to cerebrovascular accidents (strokes) in the brain, left ventricular hypertrophy or heart failure in the heart, and chronic kidney disease in the kidneys.

The skin, while it can manifest peripheral effects from hypertension, such as changes in blood flow or a more superficial impact on condition, is not directly affected by hypertension in the same critical way as the other organs. Therefore, the skin is not typically impacted in the direct sequelae of unmanaged hypertension, making it the correct answer to the question. This distinction highlights the significant organ systems that actively respond to the stress of hypertension compared to those that may not be as critically affected.