Background: Epicardial adipose tissue is an emerging cardio metabolic risk factor. Although an association between epicardial fat thickness (EFT) and left ventricle (LV) hypertrophy in hypertensive patients is known, the relationship between abnormal LV geometric patterns and EFT has yet to be investigated. The aim of the present study was to investigate the relationship between EFT and abnormal LV geometric patterns in hypertensive patients. Methods: Measurements were obtained from 343 patients with untreated essential hypertension (mean age 51.6  5.5 years) and 52 healthy control subjects (mean age 51.8  4.5 years). Four different geometric patterns (NG; normal geometry, CR; concentric remodeling, EH; eccentric hypertrophy, and CH; concentric hypertrophy) were determined according to LVmass index (LVMI) and relative wall thickness (RWt). EFT wasmeasured using transthoracic echocardiography. High sensitive C-reactive protein (hs-CRP) and other biochemical markers were measured in all participants. Results: The highest EFT and hs-CRP values were determined in the CH group (EFT = 8.9  2.1 mm) compared with the controls (EFT = 5.7  1.5 mm), followed by the NG (EFT = 5.9  1.6 mm), CR (EFT = 5.9  1.3 mm) and EH groups (EFT = 6.5  1.6 mm) (all p < 0.05). In addition, the EFT values of the EH group were higher than the control, NG and CR groups (all p < 0.05).Multivariate linear regression analysis showed that EFTwas independently associated with LV geometry ( = 0.161, p = 0.032), total cholesterol level ( = -0.129, p = 0.003), triglyceride level ( = 0.266, p < 0.001), hs-CRP level ( = 0.349, p < 0.001), and creatinine level ( = 0.108, p = 0.010). Conclusions: EFT is independently associated with abnormal LV geometry, LV hypertrophy, creatinine level, and low grade chronic inflammation.