The aim of this study was to evaluate whether urapidil, an a1-adrenoceptor antagonist and 5-HT1A receptor agonist, could provide additional therapeutic benefits compared with nitroglycerin (NG) in acute heart failure with preserved ejection fraction (HFpEF) or acute heart failure with reduced ejection fraction (HFrEF) concomitant by hypertension. This study enrolled a total of 194 patients who had been diagnosed with acute HFpEF or acute HFrEF from multiple medical centers between August 2011 and November 2013. Urapidil (100 mg/day) and NG (10 mg/day) were diluted in 50 mL of 0.9% normal saline and intravenously delivered to patients within periods of 48 to 140 hours. Related clinical indexes were routinely monitored and analyzed with specific statistical procedure. In both acute HFpEF group and acute HFrEF group, compared with NG, urapidil has a remarkable time-dependent reducing effect on multiple clinical indexes, including SBP, DBP, HR and NT-proBNP (72-hour and 7-day). Compared with HFrEF group, HFpEF group had lower levels of SBP, NT-proBNP (72-hour and 7-day) and LA response to urapidil treatment, and LVEF level in HFpEF group was improved significantly after 7-day urapidil treatment, suggesting that urapidil treatment make HFpEF patients benefit more. There was no significant difference of blood pressure between two groups after urapidil treatment. For acute HFpEF and HFrEF patients with hypertension, intravenous administration of urapidil is a promising treatment for the better control of blood pressure and preserved cardiac function. Urapidil treatment should be recommended for HFpEF.