If you’re using nVidia control panels V-Sync and more than one monitor the sim will halve it.
Using nVidia’s sync option over the games is fraught with difficulties.
It’s best to use the games V-Sync and halve or third your refresh rate for the desired frame cap.
I currently run my monitor at 100hrz and set it to cap at half for GA, 1/3 for complex aftermarket aircraft.
(my monitor is capable of 165hrz)
Oh and OP as for your settings, hit the ultra preset then turn Clouds and Contact Shadows down to high, save and enjoy.