Orthostatic hypotension (OH) occurs during body posture changes from supine to standing within few minutes. There have been several reports that pacemaker therapy improved the symptoms of drug refractory OH. An 83 year old male patient presented to us with recurrent syncopal episodes. The patient was having drug-refractory OH and sinus bradycardia with chronotropic incompetence.  TheProtos DR/CLS (Biotronik, Germany) cardiac pacemaker was implanted. This pacemaker has a rate response function of closed loop stimulation (CLS). The CLS function continuously monitors cardiac contraction dynamics through intracardiac local electrical impedance measurement via a ventricular pacing lead, and translates the cardiac contraction dynamics into its pacing rates. We evaluated the effectiveness of the DDD-CLS pacing for the change of his blood pressure (BP) and heart rate (HR) during tilt test comparing to DDD mode. In the DDD mode, after tilt test, the patient’s HR was hold in 46 bpm, and systolic BP was dropped from 110 mmHg to 67 mmHg. The patient developed symptoms of pre-syncope during postural changes. In the DDD-CLS mode, a systolic BP dropped from 129 mmHg to 91 mmHg after tilting, but at almost same time, pacing HR was increased 18 ppm, from 61 ppm to 79 ppm, and the systolic BP was increased to 103 mmHg in 3 minutes. Thereafter, pacing rate was gradually decreased to 65 ppm and systolic BP was maintained at around 95 mmHg. Syncopal recurrence was not exhibited during postural changes setting to the DDD-CLS mode. The rate response function of CLS mode could be suppressed OH patient’s syncopal episode with chronotropic incompetence and improve quality of life of the patient suffering from OH.