Climate change and urbanization are altering urban flood pressure, raising questions about whether urban adaptive capacity can keep pace with these changes. This study examined flood pressure, adaptive capacity, and their coordination across 14 cities in the core development area of the Central Plains Urban Agglomeration, China, from 2016 to 2023. The entropy weight method, coupling coordination degree model, and four-quadrant classification were integrated to assess spatiotemporal patterns and transitions in pressure–adaptation combinations. The regional flood pressure index increased overall from 0.2549 in 2016 to 0.3028 in 2023, with fluctuations, while the adaptive capacity index rose steadily from 0.2730 to 0.5293. The regional mean coupling coordination degree increased from 0.5917 to 0.7626, and intercity differences narrowed. Pressure–adaptation combinations shifted from a predominance of low-adaptation types toward high-adaptation types: 13 of 14 cities were classified as low-adaptation types in 2016, whereas all 14 were in high-adaptation categories by 2023, including nine high-pressure–high-adaptation and five low-pressure–high-adaptation cities. These findings provide a scientific basis for differentiated urban flood management and adaptive capacity planning.