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Epicardial adipose tissue(EAT) exerts cardiometabolic effects on myocardium and could be related with cardiac geometrical changes. Both obesity and hypertension are considered common risk factors for left ventricular remodeling. But the relation between obesity and hypertension with LV geometry changes have not been examined by considering EAT. We hypothesized that higher EAT thickness may contribute the LV geometrical changes in hypertensive patients.247 female patients(mean age 59.2 ± 10.4) from KoROSE study were enrolled. EAT thickness was measured by echocardiography. Obesity was defined as BSI > 25Kg/m2. LV geometry was classified as normal(LVMI < 95 g/m2 and regional wall thickness(RWT < 0.42), concentric remodeling(LVMI < 95 g/m2 and RWT≥0.42), left ventricular hypertrophy(LVH, LVMI > 95 g/m2).In 247 patients, 103 patients(41.7%) had hypertension and 122 patients (49.6%) had obesity. The prevalence of obesity was higher in hypertensive patients (60.2% vs 42.0%, P = 0.005). LVH was present in 47 patients (48.0%) of hypertension and 33 patients(24.3%) of normotensive patients(P < 0.001). The presence of obesity was frequent in normotensives with LVH(24.3%) than without LVH. But in hypertensive group, the incidence of obesity was not different according to LVH (52.9% vs 68.1%, P = 0.129).EAT thickness were compared by the presence of LVH and obesity in normotensive patients and hypertensive patients(Figure 1). In normotensive patients, EAT thickness was higher in patients with obesity or LVH. In hypertensive patients the difference of EAT thickness was showed by the presence of LVH, only. In patients with hypertension, EAT thickness was increased according to the deterioration of LV remodeling process (Table 1). EAT thickness was related with age, presence of obesity, the presence of hypertension and LVH. But, by multivariate analysis, only LVH was related with EAT with statistical significance (OR = 2.13, P = 0.035).As EAT thickness was independently related with the presence of LVH, irrespective of confounding effect from obesity, EAT thickness was related with progressive LV geometrical change.