All depends what your issues are and your goal.
Nvidia settings will override AH settings.
2 key settings is Anti-aliasing (AA), let AH control that if its checked in AH.
V-Sync, off will deliver higher FPS, however you may see tearing. Setting it in Nvidia to Fast is the same as off, but prevents tearing.
In Nvidia set a limit on Frame Rate to match refresh rate on you monitor. Any frames higher than your refresh rate will be discarded, making you card run harder and hotter for no increase past that. A cooler card runs better, heat will wear it out.