You don't mention your weight. If you're obese, losing weight should lower your BP.
However, I would never take meds unless my doctor did a 24/7 monitor of my BP (there's something they give you to wear). My own BP is almost always higher at the doctor's office, and my primary had a tech for a long time who took my BP inaccurately. I kept telling him that, and he ignored me. She left, and there's a new person. Guess what? Now my BP is the same there as everywhere else. So there are a variety of reasons why BP can be inaccurate.
You mention the tightness of the cuff. Pain can drive up your BP instantly and show an inaccurately high reading because the cuff is too tight.
By the way, when I was obese, I always needed the larger cuff (otherwise the BP isn't accurate). Several times I had to remind them to use the larger cuff, and they often did it reluctantly because it means extra work for them to change the cuff. Since you mention the tightness, could that be an issue for you?
BP medications are great for those who really need them because high BP is very damaging. However, they are also very powerful drugs, and I would never take them unless I was absolutely sure that I needed them. It's a lot easier for doctors to prescribe meds than to check to insure that you really need them, so I'd be careful.