Rapid urbanization, water pollution, climate change and inadequate maintenance of water and wastewater infrastructures in cities may lead to flooding, water scarcity, adverse health effects, and rehabilitation costs that may overwhelm the resilience of cities. Furthermore, Integrated Water Resources Management (IWRM) is hindered by water governance gaps. We have analyzed IWRM in 45 municipalities and regions divided over 27 countries using the improved City Blueprint® Framework (CBF). The CBF incorporates solely performance-oriented indicators that more accurately measure the city's own efforts and performances to improve its IWRM. We have also analyzed the trends and pressures (on which the city's IWRM has a negligible influence). The Trends and Pressure Framework (TPF) creates awareness of the most stressing topics that either hamper or, on the contrary, pose opportunity windows for IWRM. The improved Blue City Index (BCI*) and the Trends and Pressures Index (TPI; the arithmetic mean of all TPF indicators) have been compared with other city descriptors. The BCI* and TPI showed a significant and negative Pearson correlation (r=−0.83). This implies that cities with pressing needs to improve their IWRM also face the highest environmental, financial and/or social limitations. The BCI* and TPI correlate significantly with the ND-GAIN climate readiness index (r=0.86; r=−0.94), the environmental awareness index (r=0.85; r=−0.85), the European green city index (r=0.86; r=−0.85) and various World Bank governance indicators. Based on a hierarchical clustering of the 45 municipalities and regions, 5 different levels of sustainability of urban IWRM could be distinguished, i.e., (1) cities lacking basic water services, (2) wasteful cities, (3) water efficient cities, (4) resource efficient and adaptive cities, and (5) water wise cities. This categorization, as well as the CBF and TPF are heuristic approaches to speed up the transition towards water wise cities.