Anemia, a condition characterized by low levels of hemoglobin, is frequently observed in patients with heart failure (HF). Guideline-directed medical therapy improves HF outcomes by using medications like beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin receptor blockers, along with mineralocorticoid receptor antagonists and sodium-glucose cotransporter 2 inhibitors. In this study, we aimed to review the pathophysiology of anemia in patients with HF and present the current evidence regarding the relationship between the main recommended medications for these patients and hemoglobin levels. We conducted a comprehensive search in the medical literature for relevant original clinical articles in which the four pharmacological pillars of HF were given to the patients; we, then, assessed whether the association of use of these medications and hemoglobin level or development of anemia was provided. These common medications have been shown in the literature that may exacerbate or ameliorate anemia. Besides, it has been shown that even in the case that they result in the development of anemia, their use is associated with positive effects that outweigh this potential harm. The literature also suggests that among patients receiving medications with negative effects on the level of hemoglobin, there was no difference in the rate of mortality between anemic and non-anemic patients when both were on treatment for anemia; this point highlights the importance of the detection and treatment of anemia in these patients. Further research is needed to explore these relationships and identify additional strategies to mitigate the risk of anemia in this population.