It's up to you.
There are plenty of INI tweaks on these forums that configure the game more the way we like it. Or improve the performance. However, there are also plenty that are no longer correct, or advisable, or relevant.
Personally, I don't think it would take much for the devs to make the default settings better (Vsync OFF, max FPS at video mode's rate etc.) and make more UI options available (WeaponHandPreference, WeaponBob etc.). Then far fewer people would be scratching around in the INI files.