Background: Epicardial adipose tissue (EAT) is a cardiometabolic risk factor, and its possible relationship with hypertension has been reported previously. Microalbuminuria (MA) is associated with target-organ damage, especially in patients with hypertension that develop hypertrophy and suggest endothelial dysfunction. This study aims to investigate the relationship between echocardiographic epicardial adipose tissue (EAT) thickness and MA in patients with newly diagnosed hypertrophic hypertension. Methods: We included the newly diagnosed HT patients who applied to the outpatient clinic in a consecutive study. Patients were divided into two groups according to the presence of hypertrophy in echocardiography. We set a control group and equalized them in terms of age and gender. All subjects underwent transthoracic echocardiography to measure EAT thickness. Spot urine sample was collected for the assessment of MA. Then, appropriate statistical tests were carried out. Results: In the group with left ventricular hypertrophy (LVH), we found EFT thicknesses and MA development rate significantly higher than the other two groups (5.1 ± 1.3 vs 5.3 ± 1.5 vs 6.6 ± 1.8, P <0.001; respectively). In the group without LVH, no relationship was found between MA and EFT. In multiple regression analyses, we determined EFT thickness (OR: 3.141 [95% CI: 2.425-6.123], P <0.001) and left ventricular mass index value (OR: 1.339 [95% CI: 1.145-2.143], P = 0.003) as independent predictors for MA development in the group with LVH. Conclusion: We think that EFT is a simple, effective and feasible method to predict target organ damage, especially in HT patients with LVH.