Do you ramp everything up and just forget about it, keep everything on low and get hundreds of fps higher than your monitor can support just to get a few milliseconds faster response times, find a nice balance of settings, or perhaps you take it one step further and play in a stretched 4:3 aspect ratio like we're still in the 90s?
While I don't have a super high end PC, I personally tend to set everything to the highest setting that lets my PC still max out my monitor and drop setting if need be.