Napier City Council agreed to adopt the review earlier this year, and Hastings District Council agreed last week - conditional on the regional council also agreeing to adopt.
Previously, the regional council's concerns were that the strategy did not effectively address the issue of urban development on fertile soils, had a timeframe which was too long and did not address issues such as "land-banking".
After a lengthy debate on whether the document addressed these concerns, all but two councillors voted to adopt the review.
One was councillor Peter Beaven, who has been outspoken against HPUDS because of the lack of protection it offers the region's soils. Yesterday he said this was among the range of issues the "fundamentally wrong" strategy still did not address.
He did not "see how any sane person can support this strategy, it's nuts".
"I've sat here over my lifetime watching Hastings expand out not up. In my lifetime I've seen 2000 hectares of land taken for that.
"The councils are incredibly lazy, they will take the easy option for the next 30 years. We need to fire a shot across their bows so they take the whole business of protecting our valuable soils seriously."
His concerns were echoed by several other councillors, and Maori committee chairman Mike Mohi.
Advocating to remain involved, councillor Fenton Wilson said: "If we support this today the issues that have been raised are going to be front and centre going forward.
"If we don't support this really what are we achieving, nothing."
Rejecting the review would mean all the work done on it was wasted, and would be an "impotent move", councillor Alan Dick said.
"Napier and Hastings will simply just carry on and do their developments in accordance with the plan.
"[If we] turn this down we're really not achieving much other than we're no longer a player, as we have been."
Councillor Paul Bailey also voted against the motion. Two councillors - Rick Barker and Tom Belford - were not able to attend Wednesday's meeting.